Provider Demographics
NPI:1700973948
Name:ADVANCED PROSTHETICS AND ORTHOTICS SOLUTIONS, INC.
Entity Type:Organization
Organization Name:ADVANCED PROSTHETICS AND ORTHOTICS SOLUTIONS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CPO
Authorized Official - Prefix:
Authorized Official - First Name:SHAWN
Authorized Official - Middle Name:D
Authorized Official - Last Name:GILLESPIE
Authorized Official - Suffix:
Authorized Official - Credentials:CPO
Authorized Official - Phone:928-314-0030
Mailing Address - Street 1:2851 S AVENUE B STE 8
Mailing Address - Street 2:
Mailing Address - City:YUMA
Mailing Address - State:AZ
Mailing Address - Zip Code:85364-7726
Mailing Address - Country:US
Mailing Address - Phone:928-314-0030
Mailing Address - Fax:928-331-4004
Practice Address - Street 1:2851 S AVENUE B STE 8
Practice Address - Street 2:
Practice Address - City:YUMA
Practice Address - State:AZ
Practice Address - Zip Code:85364-7726
Practice Address - Country:US
Practice Address - Phone:928-314-0030
Practice Address - Fax:928-314-0040
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-09
Last Update Date:2021-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ539918Medicaid
AZ189878600OtherOWCP/ACS
AZAZ0278110OtherBLUE CROSS BLUE SHIELD OF AZ
AZ3880450001Medicare NSC