Healthcare Provider Details

I. General information

NPI: 1376624593
Provider Name (Legal Business Name): ULTRA PROSTHETICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/17/2006
Last Update Date: 12/14/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 AFFONSO DR STE G
CARSON CITY NV
89706-7794
US

IV. Provider business mailing address

PO BOX 22201
CARSON CITY NV
89721-2201
US

V. Phone/Fax

Practice location:
  • Phone: 800-858-7276
  • Fax: 775-882-1561
Mailing address:
  • Phone: 800-858-7276
  • Fax: 775-882-1561

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number72165
License Number StateNV

VIII. Authorized Official

Name: DANIEL O HANEY
Title or Position: OWNER
Credential: C.P.
Phone: 800-858-7576