Provider Demographics
NPI:1841211992
Name:WEST COAST ORTHOTIC & PROSTHETIC SERVICES INC
Entity Type:Organization
Organization Name:WEST COAST ORTHOTIC & PROSTHETIC SERVICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CONTRACT CORDINATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:K
Authorized Official - Last Name:CREE
Authorized Official - Suffix:SR
Authorized Official - Credentials:
Authorized Official - Phone:209-845-8231
Mailing Address - Street 1:693 HI TECH PKWY
Mailing Address - Street 2:
Mailing Address - City:OAKDALE
Mailing Address - State:CA
Mailing Address - Zip Code:95361-9372
Mailing Address - Country:US
Mailing Address - Phone:209-845-8231
Mailing Address - Fax:209-845-2883
Practice Address - Street 1:3215 N CALIFORNIA ST
Practice Address - Street 2:STE 2
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95204
Practice Address - Country:US
Practice Address - Phone:209-942-4166
Practice Address - Fax:209-942-4168
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-22
Last Update Date:2008-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225000000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotic FitterGroup - Single Specialty
No335E00000XSuppliersProsthetic/Orthotic SupplierGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA0212880004Medicare NSC