=====================================================
General NPI Number Information
=====================================================
NPI Number | 1265244867
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ADVANCE ORTHOTIC PROSTHETIC SERVICES, INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/22/2025
-----------------------------------------------------
Last Update Date | 01/22/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 260 WESTERN AVE
-----------------------------------------------------
City | SOUTH PORTLAND
-----------------------------------------------------
State | ME
-----------------------------------------------------
Zip | 04106-2445
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 207-786-7022
-----------------------------------------------------
Fax | 207-777-1787
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 207 N RIVER RD
-----------------------------------------------------
City | AUBURN
-----------------------------------------------------
State | ME
-----------------------------------------------------
Zip | 04210-9479
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 207-786-7022
-----------------------------------------------------
Fax | 207-777-1787
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OPERATION MANAGER
-----------------------------------------------------
Name | APRIL ANDERSON
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 207-786-7022
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 332BC3200X
-----------------------------------------------------
Taxonomy Name | Customized Equipment (DME)
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------