Provider Demographics
NPI:1952149692
Name:MERCY PROSTHETICS & ORTHOTICS GROUP
Entity type:Organization
Organization Name:MERCY PROSTHETICS & ORTHOTICS GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CERTIFIED PROSTHETIST ORTHTOTIST
Authorized Official - Prefix:MR
Authorized Official - First Name:MENA
Authorized Official - Middle Name:SALAMA
Authorized Official - Last Name:MANOLLY
Authorized Official - Suffix:
Authorized Official - Credentials:CPO
Authorized Official - Phone:951-966-7661
Mailing Address - Street 1:1390 E 6TH ST STE 4
Mailing Address - Street 2:
Mailing Address - City:BEAUMONT
Mailing Address - State:CA
Mailing Address - Zip Code:92223-2516
Mailing Address - Country:US
Mailing Address - Phone:951-966-7661
Mailing Address - Fax:
Practice Address - Street 1:1390 E 6TH ST STE 4
Practice Address - Street 2:
Practice Address - City:BEAUMONT
Practice Address - State:CA
Practice Address - Zip Code:92223-2516
Practice Address - Country:US
Practice Address - Phone:951-966-7661
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-17
Last Update Date:2025-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
No222Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotistGroup - Multi-Specialty
No224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetistGroup - Multi-Specialty