Provider Demographics
NPI:1295048577
Name:INNOVATIVE PROSTHETICS & ORTHOTICS
Entity type:Organization
Organization Name:INNOVATIVE PROSTHETICS & ORTHOTICS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:RAKESH
Authorized Official - Middle Name:K
Authorized Official - Last Name:SRIVASTAVA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:402-461-4931
Mailing Address - Street 1:223 E 14TH ST STE 5
Mailing Address - Street 2:
Mailing Address - City:HASTINGS
Mailing Address - State:NE
Mailing Address - Zip Code:68901-3240
Mailing Address - Country:US
Mailing Address - Phone:402-461-4931
Mailing Address - Fax:402-461-4932
Practice Address - Street 1:9202 W DODGE RD STE 110
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68114-3318
Practice Address - Country:US
Practice Address - Phone:402-933-1393
Practice Address - Fax:402-933-1899
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-15
Last Update Date:2014-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier