Healthcare Provider Details

I. General information

NPI: 1962576835
Provider Name (Legal Business Name): HANGER PROSTHETICS & ORTHOTICS EAST INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/20/2006
Last Update Date: 08/14/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

318 N 8TH ST
MANITOWOC WI
54220-4008
US

IV. Provider business mailing address

318 N 8TH ST
MANITOWOC WI
54220-4008
US

V. Phone/Fax

Practice location:
  • Phone: 920-682-8088
  • Fax:
Mailing address:
  • Phone: 920-682-8088
  • Fax:

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

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier41791500
Identifier TypeMEDICAID
Identifier StateWI
Identifier Issuer

VIII. Authorized Official

Name: SHERYL PRICE
Title or Position: DIR OF REIMBURSEMENT
Credential:
Phone: 503-493-8288