Provider Demographics
NPI:1790054047
Name:DOUG HODGE ORTHOTICS
Entity Type:Organization
Organization Name:DOUG HODGE ORTHOTICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:BRYANT
Authorized Official - Last Name:HODGE
Authorized Official - Suffix:
Authorized Official - Credentials:CO
Authorized Official - Phone:317-844-8107
Mailing Address - Street 1:1322 ANNAPOLIS DR
Mailing Address - Street 2:
Mailing Address - City:WESTFIELD
Mailing Address - State:IN
Mailing Address - Zip Code:46074-8120
Mailing Address - Country:US
Mailing Address - Phone:317-844-8107
Mailing Address - Fax:
Practice Address - Street 1:1322 ANNAPOLIS DR
Practice Address - Street 2:
Practice Address - City:WESTFIELD
Practice Address - State:IN
Practice Address - Zip Code:46074-8120
Practice Address - Country:US
Practice Address - Phone:317-844-8107
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-15
Last Update Date:2011-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier