Provider Demographics
NPI:1013687821
Name:MAUGHAN PROSTHETIC & ORTHOTIC, INC.
Entity Type:Organization
Organization Name:MAUGHAN PROSTHETIC & ORTHOTIC, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LCPO/OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JUSTIN
Authorized Official - Middle Name:M
Authorized Official - Last Name:MAUGHAN
Authorized Official - Suffix:
Authorized Official - Credentials:LCPO
Authorized Official - Phone:360-698-2229
Mailing Address - Street 1:PO BOX 1546
Mailing Address - Street 2:
Mailing Address - City:GRAHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98338-1546
Mailing Address - Country:US
Mailing Address - Phone:360-447-0770
Mailing Address - Fax:253-904-8705
Practice Address - Street 1:1805 COOKS HILL RD
Practice Address - Street 2:
Practice Address - City:CENTRALIA
Practice Address - State:WA
Practice Address - Zip Code:98531-9072
Practice Address - Country:US
Practice Address - Phone:360-330-1602
Practice Address - Fax:360-807-4511
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MAUGHAN PROSTHETIC & ORTHOTIC, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-09-14
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier