Provider Demographics
NPI:1881088730
Name:WRIGHT MEDICAL CORPORATION
Entity type:Organization
Organization Name:WRIGHT MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BENNY
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:WRIGHT
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:209-826-4771
Mailing Address - Street 1:600 W I ST
Mailing Address - Street 2:SUITE C
Mailing Address - City:LOS BANOS
Mailing Address - State:CA
Mailing Address - Zip Code:93635-3460
Mailing Address - Country:US
Mailing Address - Phone:209-826-4771
Mailing Address - Fax:209-826-8565
Practice Address - Street 1:600 W I ST
Practice Address - Street 2:SUITE C
Practice Address - City:LOS BANOS
Practice Address - State:CA
Practice Address - Zip Code:93635-3460
Practice Address - Country:US
Practice Address - Phone:209-826-4771
Practice Address - Fax:209-826-8565
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-27
Last Update Date:2017-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACA132617Medicare UPIN