MEDICARE: ORTHOSOURCE, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332B00000X	Durable Medical Equipment & Medical Supplies

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	036957	OTHER	NE	BLUE CROSS BLUE SHIELD
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1053395350
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ORTHOSOURCE, INC.

Provider Business Mailing Address
First Line	:	13839 INDUSTRIAL RD
Second Line	:
City	:	OMAHA
State	:	NE
Zip	:	68137-1117
Country	:	US
Telephone Number	:	402-408-0777
Fax Number	:	402-933-5523

Provider Business Practice Location Address
First Line	:	13839 INDUSTRIAL RD
Second Line	:
City	:	OMAHA
State	:	NE
Zip	:	68137-1117
Country	:	US
Telephone Number	:	402-408-0777
Fax Number	:	402-933-5523

Authorized Official
Title or Position	:	MANAGER/ATHLETIC TRAINER
Name	:	STEVE RONSPIES
Credential	:	ATC
Telephone Number	:	402-861-6683

Provider Enumeration Date	:	12/01/2005
Last Update Date	:	08/23/2016

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Directions to “ORTHOSOURCE, INC. ” Practice Location

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