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General NPI Number Information
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NPI Number | 1750693982
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Entity Type | Organization
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Legal Business Name | ORTHOTIC & PROSTHETIC CARE, INC.
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Dates
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Enumeration Date | 07/02/2010
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Last Update Date | 07/02/2010
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Provider Practice Location Address
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Address Line | 236 E HATCHER RD
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City | PHOENIX
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State | AZ
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Zip | 85020-2423
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Country | US
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Telephone | 602-561-6450
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Fax | 623-321-1215
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Provider Business Mailing Address
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Address Line | PO BOX 31188
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City | PHOENIX
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State | AZ
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Zip | 85046-1188
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Country | US
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Telephone | 602-561-6450
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Fax | 623-321-1215
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Authorized Official
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Title or Position | OWNER
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Name | THOMAS DAVID HAMM
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Credential | BOCO
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Telephone | 602-561-6450
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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 | C46714
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License Number State | AZ
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