Provider Demographics
NPI:1962643007
Name:ANCHOR ORTHOTICS & PROSTHETICS, INC
Entity Type:Organization
Organization Name:ANCHOR ORTHOTICS & PROSTHETICS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TERRY
Authorized Official - Middle Name:
Authorized Official - Last Name:MCDONALD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:916-484-0658
Mailing Address - Street 1:PO BOX 300
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:CA
Mailing Address - Zip Code:95604-0300
Mailing Address - Country:US
Mailing Address - Phone:530-887-1734
Mailing Address - Fax:530-887-8491
Practice Address - Street 1:11990 HERITAGE OAK PL
Practice Address - Street 2:SUITE 12
Practice Address - City:AUBURN
Practice Address - State:CA
Practice Address - Zip Code:95603-2455
Practice Address - Country:US
Practice Address - Phone:530-887-1734
Practice Address - Fax:530-887-8491
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-19
Last Update Date:2009-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAGXC000890335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier