Provider Demographics
NPI:1720126824
Name:CAPSTONE ORTHOPEDIC, INC.
Entity Type:Organization
Organization Name:CAPSTONE ORTHOPEDIC, INC.
Other - Org Name:ADVANCED PROSTHETIC & ORTHOTIC DESIGNS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:GLEN
Authorized Official - Middle Name:STEPHEN
Authorized Official - Last Name:ELLIS
Authorized Official - Suffix:
Authorized Official - Credentials:CPO
Authorized Official - Phone:209-612-6168
Mailing Address - Street 1:3553 CASTRO VALLEY BLVD
Mailing Address - Street 2:SUITE B
Mailing Address - City:CASTRO VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:94546-4400
Mailing Address - Country:US
Mailing Address - Phone:510-537-1210
Mailing Address - Fax:510-537-1082
Practice Address - Street 1:7015 N CHESTNUT AVE
Practice Address - Street 2:SUITE 103
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93720-0349
Practice Address - Country:US
Practice Address - Phone:559-298-0321
Practice Address - Fax:559-298-7164
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CAPSTONE ORTHOPEDIC, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-02-01
Last Update Date:2012-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGXC 000923Medicaid
CAGXC 000923Medicaid