Provider Demographics
NPI:1679140677
Name:CAPSTONE ORTHOPEDIC, INC
Entity type:Organization
Organization Name:CAPSTONE ORTHOPEDIC, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF OPERATION OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:GLEN
Authorized Official - Middle Name:STEPHEN
Authorized Official - Last Name:ELLIS
Authorized Official - Suffix:
Authorized Official - Credentials:CEO
Authorized Official - Phone:209-612-6168
Mailing Address - Street 1:2995 R ST STE 102
Mailing Address - Street 2:
Mailing Address - City:MERCED
Mailing Address - State:CA
Mailing Address - Zip Code:95348-2037
Mailing Address - Country:US
Mailing Address - Phone:209-349-8359
Mailing Address - Fax:209-580-4675
Practice Address - Street 1:2995 R ST STE 102
Practice Address - Street 2:
Practice Address - City:MERCED
Practice Address - State:CA
Practice Address - Zip Code:95348-2037
Practice Address - Country:US
Practice Address - Phone:209-349-8359
Practice Address - Fax:209-580-4675
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-08
Last Update Date:2024-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier