Provider Demographics
NPI:1053719633
Name:PEDIATRIC ORTHOTIC AND PROSTHETIC SERVICES - NORTHWEST, LLC
Entity type:Organization
Organization Name:PEDIATRIC ORTHOTIC AND PROSTHETIC SERVICES - NORTHWEST, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROSTHETIST / ORTHOTIST
Authorized Official - Prefix:
Authorized Official - First Name:PETER
Authorized Official - Middle Name:
Authorized Official - Last Name:SPRINGS
Authorized Official - Suffix:
Authorized Official - Credentials:L/CPO
Authorized Official - Phone:509-252-3373
Mailing Address - Street 1:PO BOX 865109
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32886-5109
Mailing Address - Country:US
Mailing Address - Phone:844-602-3960
Mailing Address - Fax:813-281-8461
Practice Address - Street 1:911 W 5TH AVE
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99204-2901
Practice Address - Country:US
Practice Address - Phone:509-252-3373
Practice Address - Fax:509-744-1229
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PEDIATRIC ORTHOTIC AND PROSTHETIC SERVICES - NORTHWEST, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-12-12
Last Update Date:2015-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies