Provider Demographics
NPI:1740720366
Name:HANGER CLINIC
Entity type:Organization
Organization Name:HANGER CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ORTHOTIST/PROSTHETIST
Authorized Official - Prefix:
Authorized Official - First Name:SHELBY
Authorized Official - Middle Name:RAE
Authorized Official - Last Name:GROPPUSO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:360-423-6049
Mailing Address - Street 1:1516 HUDSON ST
Mailing Address - Street 2:SUITE 105
Mailing Address - City:LONGVIEW
Mailing Address - State:WA
Mailing Address - Zip Code:98632-3083
Mailing Address - Country:US
Mailing Address - Phone:360-423-6049
Mailing Address - Fax:360-425-3690
Practice Address - Street 1:1516 HUDSON ST
Practice Address - Street 2:SUITE 105
Practice Address - City:LONGVIEW
Practice Address - State:WA
Practice Address - Zip Code:98632-3083
Practice Address - Country:US
Practice Address - Phone:360-423-6049
Practice Address - Fax:360-425-3690
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-01
Last Update Date:2017-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier