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General NPI Number Information
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NPI Number | 1619341567
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Entity Type | Organization
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Legal Business Name | WEST COAST ORTHOTICS AND PROSTHETICS
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Dates
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Enumeration Date | 11/16/2015
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Last Update Date | 11/16/2015
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Provider Practice Location Address
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Address Line | 4915 STANTON BLVD
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City | MONTAGUE
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State | MI
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Zip | 49437-1039
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Country | US
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Telephone | 231-894-0045
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Fax |
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Provider Business Mailing Address
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Address Line | 4915 STANTON BLVD
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City | MONTAGUE
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State | MI
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Zip | 49437-1039
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Country | US
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Telephone | 231-894-0045
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | MR. JOSHUA C RYDER
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Credential | CO
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Telephone | 231-894-0045
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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 | CO2476
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License Number State | VA
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