=====================================================
General NPI Number Information
=====================================================
NPI Number | 1962682906
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ADVANCED PROSTHETIC & ORTHOTIC CENTER, INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/07/2007
-----------------------------------------------------
Last Update Date | 09/16/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 8511 WOODWINDS WAY
-----------------------------------------------------
City | YAKIMA
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98908-1445
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 509-480-0806
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 8511 WOODWINDS WAY
-----------------------------------------------------
City | YAKIMA
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98908-1445
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 509-480-0806
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | GARY THOMPSON
-----------------------------------------------------
Credential | LPO,CPO
-----------------------------------------------------
Telephone | 509-480-0806
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 335E00000X
-----------------------------------------------------
Taxonomy Name | Prosthetic/Orthotic Supplier
-----------------------------------------------------
License Number | PS00000366/OI0000038
-----------------------------------------------------
License Number State | WA
-----------------------------------------------------