MEDICARE: WEST COAST MOBILE ORTHOPEDICS, 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

General Provider Information

NPI Number	:	1871771667
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WEST COAST MOBILE ORTHOPEDICS, INC.

Provider Business Mailing Address
First Line	:	8951 BONITA BEACH RD. STE#525-194
Second Line	:
City	:	BONITA SPRINGS
State	:	FL
Zip	:	34135-4208
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	24643 RED ROBIN DRIVE
Second Line	:
City	:	BONITA SPRINGS
State	:	FL
Zip	:	34135-4208
Country	:	US
Telephone Number	:	239-947-7906
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	CHRIS LOUIS RIEGER
Credential	:
Telephone Number	:	239-947-7906

Provider Enumeration Date	:	02/05/2008
Last Update Date	:	02/05/2008

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