Provider Demographics
NPI:1891902524
Name:CHANNEL ISLANDS PROSTHETICS-ORTHOTICS
Entity Type:Organization
Organization Name:CHANNEL ISLANDS PROSTHETICS-ORTHOTICS
Other - Org Name:M. WARMUTH C.O. INC.
Other - Org Type:Other Name
Authorized Official - Title/Position:PRES.
Authorized Official - Prefix:MR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:J
Authorized Official - Last Name:WARMUTH
Authorized Official - Suffix:
Authorized Official - Credentials:CO
Authorized Official - Phone:805-658-1822
Mailing Address - Street 1:4517 MARKET ST
Mailing Address - Street 2:STE 4
Mailing Address - City:VENTURA
Mailing Address - State:CA
Mailing Address - Zip Code:93003-7710
Mailing Address - Country:US
Mailing Address - Phone:805-658-1822
Mailing Address - Fax:805-658-1824
Practice Address - Street 1:4517 MARKET ST
Practice Address - Street 2:STE 4
Practice Address - City:VENTURA
Practice Address - State:CA
Practice Address - Zip Code:93003-7710
Practice Address - Country:US
Practice Address - Phone:805-658-1822
Practice Address - Fax:805-658-1824
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-16
Last Update Date:2009-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA3831540001Medicare NSC
CA0136812Medicare PIN