=====================================================
General NPI Number Information
=====================================================
NPI Number | 1306641493
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PALIKU PROSTHETICS & ORTHOTICS INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/13/2025
-----------------------------------------------------
Last Update Date | 02/13/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 360 HOOHANA ST STE 105
-----------------------------------------------------
City | KAHULUI
-----------------------------------------------------
State | HI
-----------------------------------------------------
Zip | 96732-3504
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 809-909-2296
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 4747
-----------------------------------------------------
City | MEDFORD
-----------------------------------------------------
State | OR
-----------------------------------------------------
Zip | 97501-0196
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 346-326-7029
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | FOREST SEXTON
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 541-601-6666
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 335E00000X
-----------------------------------------------------
Taxonomy Name | Prosthetic/Orthotic Supplier
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------