Healthcare Provider Details

I. General information

NPI: 1013275874
Provider Name (Legal Business Name): ELITE BIOMECHANICAL DESIGN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/30/2012
Last Update Date: 11/26/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2208 5TH AVE
OROVILLE CA
95965-5816
US

IV. Provider business mailing address

9 GOVERNORS LN
CHICO CA
95926-1991
US

V. Phone/Fax

Practice location:
  • Phone: 530-534-6913
  • Fax: 530-533-4617
Mailing address:
  • Phone: 530-894-6913
  • Fax: 530-894-6915

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MR. MICHAEL PATRICK CASEY
Title or Position: CEO, CFO
Credential: BOCO
Phone: 530-894-6913