1518448638 NPI number — ADVANCED PROSTHETICS AND ORTHOTICS LLC

Table of content: (NPI 1518448638)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1518448638 NPI number — ADVANCED PROSTHETICS AND ORTHOTICS LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ADVANCED PROSTHETICS AND ORTHOTICS LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
KORMYLO ORTHOPEDIC
Provider Other Organization Name Type Code:
5
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1518448638
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/19/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
904 S VANGUARD WAY STE 100
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MERIDIAN
Provider Business Mailing Address State Name:
ID
Provider Business Mailing Address Postal Code:
83642-7552
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
208-466-4360
Provider Business Mailing Address Fax Number:
844-274-2789

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1070 N CURTIS RD STE 150
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BOISE
Provider Business Practice Location Address State Name:
ID
Provider Business Practice Location Address Postal Code:
83706-1248
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
208-377-4024
Provider Business Practice Location Address Fax Number:
844-274-2789
Provider Enumeration Date:
08/27/2018

Additional Information

Authorized Official

Authorized Official Last Name:
MCDONALD
Authorized Official First Name:
STEPHANIE
Authorized Official Middle Name:
WALKER
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
208-985-5190

Provider Taxonomy Codes

  • Taxonomy code: 224P00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 335E00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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