Provider Demographics
NPI:1245438613
Name:DECKER INTEGRATED ORTHOTICS AND PROSTHETICS, LLC
Entity type:Organization
Organization Name:DECKER INTEGRATED ORTHOTICS AND PROSTHETICS, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:LOREN
Authorized Official - Middle Name:J
Authorized Official - Last Name:DECKER
Authorized Official - Suffix:
Authorized Official - Credentials:CP
Authorized Official - Phone:913-341-2661
Mailing Address - Street 1:8931 W 75TH ST
Mailing Address - Street 2:
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66204-2208
Mailing Address - Country:US
Mailing Address - Phone:913-341-2661
Mailing Address - Fax:913-273-1313
Practice Address - Street 1:8931 W 75TH ST
Practice Address - Street 2:
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66204-2208
Practice Address - Country:US
Practice Address - Phone:913-341-2661
Practice Address - Fax:913-273-1313
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DECKER INVESTMENTS, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-07-06
Last Update Date:2016-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies