Provider Demographics
NPI:1013146083
Name:ORTHOCARE INNOVATIONS CLINICAL SERVICES LLC
Entity Type:Organization
Organization Name:ORTHOCARE INNOVATIONS CLINICAL SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RESEARCH PROSTHETIST
Authorized Official - Prefix:MR
Authorized Official - First Name:WAYNE
Authorized Official - Middle Name:K
Authorized Official - Last Name:DALY
Authorized Official - Suffix:
Authorized Official - Credentials:CPO, LPO, FA
Authorized Official - Phone:425-771-0797
Mailing Address - Street 1:6405 218TH S.W.
Mailing Address - Street 2:SUITE 301
Mailing Address - City:MOUNTLAKE TERRACE
Mailing Address - State:WA
Mailing Address - Zip Code:98043-2180
Mailing Address - Country:US
Mailing Address - Phone:425-771-0797
Mailing Address - Fax:206-219-1144
Practice Address - Street 1:6405 218TH SW
Practice Address - Street 2:SUITE 301
Practice Address - City:MOUNTLAKE TERRACE
Practice Address - State:WA
Practice Address - Zip Code:98043-2180
Practice Address - Country:US
Practice Address - Phone:425-771-0797
Practice Address - Fax:206-219-1144
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-10
Last Update Date:2014-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
No261QA0900XAmbulatory Health Care FacilitiesClinic/CenterAmputee
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA6346080001OtherCMS PTAN NUMBER