Healthcare Provider Details

I. General information

NPI: 1295048577
Provider Name (Legal Business Name): INNOVATIVE PROSTHETICS & ORTHOTICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/15/2010
Last Update Date: 05/07/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9202 W DODGE RD STE 110
OMAHA NE
68114-3318
US

IV. Provider business mailing address

223 E 14TH ST STE 5
HASTINGS NE
68901-3240
US

V. Phone/Fax

Practice location:
  • Phone: 402-933-1393
  • Fax: 402-933-1899
Mailing address:
  • Phone: 402-461-4931
  • Fax: 402-461-4932

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. RAKESH K SRIVASTAVA
Title or Position: OWNER
Credential:
Phone: 402-461-4931