Provider Demographics
NPI:1851621734
Name:ELITE BIOMECHANICAL DESIGN
Entity Type:Organization
Organization Name:ELITE BIOMECHANICAL DESIGN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO, CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:PATRICK
Authorized Official - Last Name:CASEY
Authorized Official - Suffix:
Authorized Official - Credentials:BOCO
Authorized Official - Phone:530-894-6913
Mailing Address - Street 1:9 GOVERNORS LN
Mailing Address - Street 2:
Mailing Address - City:CHICO
Mailing Address - State:CA
Mailing Address - Zip Code:95926-1991
Mailing Address - Country:US
Mailing Address - Phone:530-894-6913
Mailing Address - Fax:530-894-6915
Practice Address - Street 1:9 GOVERNORS LN
Practice Address - Street 2:
Practice Address - City:CHICO
Practice Address - State:CA
Practice Address - Zip Code:95926-1991
Practice Address - Country:US
Practice Address - Phone:530-894-6913
Practice Address - Fax:530-894-6915
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-28
Last Update Date:2014-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA6296139Medicaid
6344970001Medicare NSC