MEDICARE: BEVERLY HILLS PROSTHETICS ORTHOTICS, 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	335E00000X	Prosthetic/Orthotic Supplier

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1255337432
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BEVERLY HILLS PROSTHETICS ORTHOTICS, INC.

Provider Business Mailing Address
First Line	:	15230 BURBANK BLVD
Second Line	:	STE 103
City	:	SHERMAN OAKS
State	:	CA
Zip	:	91411-3534
Country	:	US
Telephone Number	:	818-988-0033
Fax Number	:	818-988-7219

Provider Business Practice Location Address
First Line	:	15230 BURBANK BLVD
Second Line	:	STE 103
City	:	VAN NUYS
State	:	CA
Zip	:	91411-3534
Country	:	US
Telephone Number	:	818-988-0033
Fax Number	:	818-988-7219

Authorized Official
Title or Position	:	PRESIDENT
Name	:	KEITH E. VINNECOUR
Credential	:	C.P.O.
Telephone Number	:	818-988-0033

Provider Enumeration Date	:	06/22/2005
Last Update Date	:	08/22/2020

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