Provider Demographics
NPI:1457786543
Name:NEVADA ORTHOTICS & PROSTHETICS INC
Entity type:Organization
Organization Name:NEVADA ORTHOTICS & PROSTHETICS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPERATIONS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:PETRA
Authorized Official - Middle Name:
Authorized Official - Last Name:THIESSEN
Authorized Official - Suffix:
Authorized Official - Credentials:CFM
Authorized Official - Phone:702-233-5500
Mailing Address - Street 1:3435 W CHEYENNE AVE
Mailing Address - Street 2:SUITE 102
Mailing Address - City:NORTH LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89032-8206
Mailing Address - Country:US
Mailing Address - Phone:702-233-5500
Mailing Address - Fax:702-233-2131
Practice Address - Street 1:2250 POSTAL DR STE 7
Practice Address - Street 2:
Practice Address - City:PAHRUMP
Practice Address - State:NV
Practice Address - Zip Code:89048-4798
Practice Address - Country:US
Practice Address - Phone:702-233-5500
Practice Address - Fax:702-233-2131
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-07
Last Update Date:2022-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1457786543Medicaid
NV6317990002Medicare NSC