Provider Demographics
NPI:1104807742
Name:ORTHORX, INC.
Entity type:Organization
Organization Name:ORTHORX, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:HOBERT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:760-795-5440
Mailing Address - Street 1:2382 FARADAY AVENUE
Mailing Address - Street 2:SUITE 300
Mailing Address - City:CARLSBAD
Mailing Address - State:CA
Mailing Address - Zip Code:92008-7220
Mailing Address - Country:US
Mailing Address - Phone:760-795-5440
Mailing Address - Fax:214-501-0299
Practice Address - Street 1:7925 YOUREE DR
Practice Address - Street 2:SUITE 230
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71105
Practice Address - Country:US
Practice Address - Phone:318-798-5583
Practice Address - Fax:318-798-5585
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-10
Last Update Date:2023-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1316296Medicaid
4330990034Medicare NSC