Healthcare Provider Details

I. General information

NPI: 1811297583
Provider Name (Legal Business Name): ORIGINAL ORTHO BACK-UP, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/28/2010
Last Update Date: 10/28/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4377 COMMERCIAL WAY 127
SPRING HILL FL
34606-1963
US

IV. Provider business mailing address

4377 COMMERCIAL WAY 127
SPRING HILL FL
34606-1963
US

V. Phone/Fax

Practice location:
  • Phone: 877-756-7846
  • Fax: 210-855-4236
Mailing address:
  • Phone: 877-756-7846
  • Fax: 210-855-4236

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State

VIII. Authorized Official

Name: MR. ERIC RITTER
Title or Position: MANAGING MEMBER
Credential:
Phone: 877-756-7846