Healthcare Provider Details

I. General information

NPI: 1679684013
Provider Name (Legal Business Name): ALPHA-OMEGA ORTHOTICS & PROSTHETICS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2021 S WAVERLY AVE STE 300
SPRINGFIELD MO
65804-2417
US

IV. Provider business mailing address

2021 S WAVERLY AVE STE 300
SPRINGFIELD MO
65804-2417
US

V. Phone/Fax

Practice location:
  • Phone: 417-886-8881
  • Fax: 417-881-8223
Mailing address:
  • Phone: 417-886-8881
  • Fax: 417-881-8223

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. RONALD A VAHL
Title or Position: PRESIDENT
Credential: CPO
Phone: 417-886-8881