Provider Demographics
NPI:1023188778
Name:ORTHOTIC PROSTHETIC ASSOCIATES, INC.
Entity type:Organization
Organization Name:ORTHOTIC PROSTHETIC ASSOCIATES, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVE
Authorized Official - Middle Name:ALFRED
Authorized Official - Last Name:JANKE
Authorized Official - Suffix:
Authorized Official - Credentials:CPO, CPED
Authorized Official - Phone:503-252-5100
Mailing Address - Street 1:173 NE 102ND AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97220-4169
Mailing Address - Country:US
Mailing Address - Phone:503-252-5100
Mailing Address - Fax:503-253-8086
Practice Address - Street 1:173 NE 102ND AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97220-4169
Practice Address - Country:US
Practice Address - Phone:503-252-5100
Practice Address - Fax:503-253-8086
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-09
Last Update Date:2009-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR229262Medicaid
OR229262Medicaid