Healthcare Provider Details

I. General information

NPI: 1306847413
Provider Name (Legal Business Name): ORTHOPRO OF ELKO INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/10/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

997 COURT ST
ELKO NV
89801-3942
US

IV. Provider business mailing address

997 COURT ST
ELKO NV
89801-3942
US

V. Phone/Fax

Practice location:
  • Phone: 775-778-0507
  • Fax: 775-778-0987
Mailing address:
  • Phone: 775-778-0507
  • Fax: 775-778-0987

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: DAVID A BLACKMAN
Title or Position: OWNER PRACTITIONER
Credential: CPO
Phone: 775-778-0507