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NPI Code Detail

MEDICARE: MUNGER PROSTHETICS AND ORTHOTICS, INC.

MEDICARE: MUNGER PROSTHETICS AND 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
1335E00000XProsthetic/Orthotic SupplierCPO01700DE

General Provider Information

NPI Number : 1942551429
Entity Type Code : Organization
Provider Name (Legal Business Name) : MUNGER PROSTHETICS AND ORTHOTICS, INC.
Provider Business Mailing Address
First Line : 5701 LAKE OTIS PKWY STE 400
Second Line :
City : ANCHORAGE
State : AK
Zip : 99507-1778
Country : US
Telephone Number : 907-743-9991
Fax Number : 907-743-9992
Provider Business Practice Location Address
First Line : 3455 REWAK DR STE 101
Second Line :
City : FAIRBANKS
State : AK
Zip : 99709-5024
Country : US
Telephone Number : 907-743-9991
Fax Number : 907-743-9992
Authorized Official
Title or Position : PRESIDENT/OWNER
Name : MR. TREVOR D MUNGER
Credential :
Telephone Number : 907-743-9991
Provider Enumeration Date : 09/25/2012
Last Update Date : 09/25/2012

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Directions to “MUNGER PROSTHETICS AND ORTHOTICS, INC. ” Practice Location

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