=====================================================
General NPI Number Information
=====================================================
NPI Number | 1346258480
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HANGER PROSTHETICS & ORTHOTICS EAST, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/04/2006
-----------------------------------------------------
Last Update Date | 04/09/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 9719 OLIVE BLVD
-----------------------------------------------------
City | OLIVETTE
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 63132-3003
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 314-567-6844
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 650846
-----------------------------------------------------
City | DALLAS
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75265-0846
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | REG COMPLIANCE SPECIALIST III
-----------------------------------------------------
Name | GRACE ANGELINE
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 714-961-2102
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 332B00000X
-----------------------------------------------------
Taxonomy Name | Durable Medical Equipment & Medical Supplies
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 335E00000X
-----------------------------------------------------
Taxonomy Name | Prosthetic/Orthotic Supplier
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------