MEDICARE: PROFESSIONAL ORTHOPEDIC SYSTEMS OF SACRAMENTO, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	335E00000X	Prosthetic/Orthotic Supplier

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1821083163
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PROFESSIONAL ORTHOPEDIC SYSTEMS OF SACRAMENTO, LLC

Provider Business Mailing Address
First Line	:	5049 COLLEGE OAK DR STE F
Second Line	:
City	:	SACRAMENTO
State	:	CA
Zip	:	95841-4630
Country	:	US
Telephone Number	:	916-331-3537
Fax Number	:	916-331-3587

Provider Business Practice Location Address
First Line	:	5049 COLLEGE OAK DR
Second Line	:	SUITE F
City	:	SACRAMENTO
State	:	CA
Zip	:	95841-4630
Country	:	US
Telephone Number	:	916-331-3537
Fax Number	:	916-331-3587

Authorized Official
Title or Position	:	OWNER
Name	:	KIM TABLADA
Credential	:	C.P.O.
Telephone Number	:	916-331-3537

Provider Enumeration Date	:	09/13/2005
Last Update Date	:	07/29/2022

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