Provider Demographics
NPI:1265904650
Name:MONARCH PROSTHETICS AND ORTHOTICS
Entity type:Organization
Organization Name:MONARCH PROSTHETICS AND ORTHOTICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RAY
Authorized Official - Middle Name:
Authorized Official - Last Name:DOLBERRY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-364-9905
Mailing Address - Street 1:544 E DEVON DR
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85296-3817
Mailing Address - Country:US
Mailing Address - Phone:480-364-9905
Mailing Address - Fax:
Practice Address - Street 1:544 E DEVON DR
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85296-3817
Practice Address - Country:US
Practice Address - Phone:480-364-9905
Practice Address - Fax:480-702-0495
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-12-22
Last Update Date:2018-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetistGroup - Multi-Specialty
No222Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotistGroup - Multi-Specialty