Provider Demographics
NPI:1255337432
Name:BEVERLY HILLS PROSTHETICS ORTHOTICS, INC.
Entity type:Organization
Organization Name:BEVERLY HILLS PROSTHETICS ORTHOTICS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KEITH
Authorized Official - Middle Name:E
Authorized Official - Last Name:VINNECOUR
Authorized Official - Suffix:
Authorized Official - Credentials:CPO
Authorized Official - Phone:818-988-0033
Mailing Address - Street 1:15230 BURBANK BLVD
Mailing Address - Street 2:STE 103
Mailing Address - City:SHERMAN OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91411-3534
Mailing Address - Country:US
Mailing Address - Phone:818-988-0033
Mailing Address - Fax:818-988-7219
Practice Address - Street 1:15230 BURBANK BLVD
Practice Address - Street 2:STE 103
Practice Address - City:VAN NUYS
Practice Address - State:CA
Practice Address - Zip Code:91411-3534
Practice Address - Country:US
Practice Address - Phone:818-988-0033
Practice Address - Fax:818-988-7219
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGXC000260Medicaid
CAGXC000260Medicaid