Healthcare Provider Details

I. General information

NPI: 1750693982
Provider Name (Legal Business Name): ORTHOTIC & PROSTHETIC CARE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/02/2010
Last Update Date: 07/02/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

236 E HATCHER RD
PHOENIX AZ
85020-2423
US

IV. Provider business mailing address

PO BOX 31188
PHOENIX AZ
85046-1188
US

V. Phone/Fax

Practice location:
  • Phone: 602-561-6450
  • Fax: 623-321-1215
Mailing address:
  • Phone: 602-561-6450
  • Fax: 623-321-1215

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License NumberC46714
License Number StateAZ

VIII. Authorized Official

Name: THOMAS DAVID HAMM
Title or Position: OWNER
Credential: BOCO
Phone: 602-561-6450