Provider Demographics
NPI:1831269125
Name:INTEGRAL ORTHOTICS & PROSTHETICS INC.
Entity type:Organization
Organization Name:INTEGRAL ORTHOTICS & PROSTHETICS INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LARRY
Authorized Official - Middle Name:D
Authorized Official - Last Name:REIB
Authorized Official - Suffix:
Authorized Official - Credentials:CO
Authorized Official - Phone:916-349-7600
Mailing Address - Street 1:5900 COYLE AVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:CARMICHAEL
Mailing Address - State:CA
Mailing Address - Zip Code:95608-0429
Mailing Address - Country:US
Mailing Address - Phone:916-349-7600
Mailing Address - Fax:916-349-7606
Practice Address - Street 1:5900 COYLE AVE
Practice Address - Street 2:SUITE B
Practice Address - City:CARMICHAEL
Practice Address - State:CA
Practice Address - Zip Code:95608-0429
Practice Address - Country:US
Practice Address - Phone:916-349-7600
Practice Address - Fax:916-349-7606
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGXC000110Medicaid
CAGXC000110Medicaid