Provider Demographics
NPI:1962655639
Name:SAWTOOTH ORTHOTICS & PROSTHETICS INC
Entity Type:Organization
Organization Name:SAWTOOTH ORTHOTICS & PROSTHETICS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:DEBRA
Authorized Official - Middle Name:L
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:CO
Authorized Official - Phone:208-846-8852
Mailing Address - Street 1:2950 E MAGIC VIEW DR
Mailing Address - Street 2:SUITE 186
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83642-3154
Mailing Address - Country:US
Mailing Address - Phone:208-846-8852
Mailing Address - Fax:208-846-8818
Practice Address - Street 1:780 S 14TH ST
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83702-6841
Practice Address - Country:US
Practice Address - Phone:208-344-9981
Practice Address - Fax:208-344-9968
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-28
Last Update Date:2008-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID0419970003Medicare NSC