Provider Demographics
NPI:1821273087
Name:MERRIAM PROSTHETICS ORTHOTICS INC
Entity Type:Organization
Organization Name:MERRIAM PROSTHETICS ORTHOTICS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:MERRIAM
Authorized Official - Last Name:S
Authorized Official - Suffix:
Authorized Official - Credentials:CPED
Authorized Official - Phone:541-386-4134
Mailing Address - Street 1:1204 13TH ST
Mailing Address - Street 2:
Mailing Address - City:HOOD RIVER
Mailing Address - State:OR
Mailing Address - Zip Code:97031-1612
Mailing Address - Country:US
Mailing Address - Phone:541-386-4134
Mailing Address - Fax:541-386-4155
Practice Address - Street 1:1204 13TH ST
Practice Address - Street 2:
Practice Address - City:HOOD RIVER
Practice Address - State:OR
Practice Address - Zip Code:97031-1612
Practice Address - Country:US
Practice Address - Phone:541-386-4134
Practice Address - Fax:541-386-4155
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-07
Last Update Date:2013-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR298541Medicaid
WA9034166Medicaid
OR0208580001Medicare NSC
OR298541Medicaid