Healthcare Provider Details

I. General information

NPI: 1114091097
Provider Name (Legal Business Name): HANGER PROSTHETICS & ORTHOTICS WEST INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/20/2006
Last Update Date: 06/23/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2251 WEST GRANTLINE ROAD SUITE 122
TRACY CA
95376
US

IV. Provider business mailing address

2251 WEST GRANTLINE ROAD SUITE 122
TRACY CA
95376
US

V. Phone/Fax

Practice location:
  • Phone: 209-832-7407
  • Fax: 209-832-7413
Mailing address:
  • Phone: 209-832-7407
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number State

VIII. Authorized Official

Name: SHERYL PRICE
Title or Position: DIR OF REIMBURSEMENT
Credential:
Phone: 503-493-8288