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General NPI Number Information
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NPI Number | 1376624593
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Entity Type | Organization
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Legal Business Name | ULTRA PROSTHETICS
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Dates
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Enumeration Date | 10/17/2006
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Last Update Date | 12/14/2015
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Provider Practice Location Address
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Address Line | 20 AFFONSO DR STE G
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City | CARSON CITY
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State | NV
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Zip | 89706-7794
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Country | US
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Telephone | 800-858-7276
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Fax | 775-882-1561
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Provider Business Mailing Address
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Address Line | PO BOX 22201
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City | CARSON CITY
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State | NV
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Zip | 89721-2201
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Country | US
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Telephone | 800-858-7276
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Fax | 775-882-1561
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Authorized Official
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Title or Position | OWNER
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Name | DANIEL O HANEY
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Credential | C.P.
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Telephone | 800-858-7576
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 335E00000X
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Taxonomy Name | Prosthetic/Orthotic Supplier
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License Number | 72165
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License Number State | NV
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