Provider Demographics
NPI:1952439796
Name:NORTH BAY PROSTHETICS AND ORTHOTICS LLC
Entity Type:Organization
Organization Name:NORTH BAY PROSTHETICS AND ORTHOTICS LLC
Other - Org Name:NAPA VALLEY PROSTHETICS AND ORTHOTICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:KYLE
Authorized Official - Middle Name:
Authorized Official - Last Name:ECKHART
Authorized Official - Suffix:
Authorized Official - Credentials:CPO
Authorized Official - Phone:707-425-5028
Mailing Address - Street 1:450 CHADBOURNE ROAD
Mailing Address - Street 2:SUITE B
Mailing Address - City:FAIRFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:94534-9612
Mailing Address - Country:US
Mailing Address - Phone:707-425-5028
Mailing Address - Fax:707-425-5029
Practice Address - Street 1:450 CHADBOURNE RD
Practice Address - Street 2:SUITE B
Practice Address - City:FAIRFIELD
Practice Address - State:CA
Practice Address - Zip Code:94534-9612
Practice Address - Country:US
Practice Address - Phone:707-425-5028
Practice Address - Fax:707-425-5029
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-02
Last Update Date:2012-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA5887210001Medicare NSC