Provider Demographics
NPI:1750693982
Name:ORTHOTIC & PROSTHETIC CARE, INC.
Entity type:Organization
Organization Name:ORTHOTIC & PROSTHETIC CARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:HAMM
Authorized Official - Suffix:
Authorized Official - Credentials:BOCO
Authorized Official - Phone:602-561-6450
Mailing Address - Street 1:PO BOX 31188
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85046-1188
Mailing Address - Country:US
Mailing Address - Phone:602-561-6450
Mailing Address - Fax:623-321-1215
Practice Address - Street 1:236 E HATCHER RD
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85020-2423
Practice Address - Country:US
Practice Address - Phone:602-561-6450
Practice Address - Fax:623-321-1215
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-02
Last Update Date:2010-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZC46714335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier