Healthcare Provider Details

I. General information

NPI: 1104807742
Provider Name (Legal Business Name): ORTHORX, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/10/2005
Last Update Date: 09/19/2023
Certification Date: 09/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7925 YOUREE DR SUITE 230
SHREVEPORT LA
71105
US

IV. Provider business mailing address

2382 FARADAY AVENUE SUITE 300
CARLSBAD CA
92008-7220
US

V. Phone/Fax

Practice location:
  • Phone: 318-798-5583
  • Fax: 318-798-5585
Mailing address:
  • Phone: 760-795-5440
  • Fax: 214-501-0299

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: KEVIN HOBERT
Title or Position: CEO/PRESIDENT
Credential:
Phone: 760-795-5440