Etheridge Prosthetics LLC

Primary specialty

ProsthetistTaxonomy code 224P00000X

License

C21410 Issued in OK

Legal business name

ETHERIDGE PROSTHETICS LLC

Practice address

2202 Westpark Dr
Suite a
Norman, OK 73069-4033

Phone

(405) 701-3733

Fax

(405) 701-3752

NPI assigned

Jun 23, 2015

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

William Robert Etheridge, BOCP LPNPI 1619363835

Title

Prosthetist

Phone

(405) 323-6936

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in OK

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

Medicare medical equipment & supply locations

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• William Robert Etheridge, BOC LP

  • Prosthetist
  • Norman, OK
  • NPI 1619363835
  NPD (past) Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1435017600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1447977600000",
    "number": "1023490349",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2202 WESTPARK DR",
            "address_2": "SUITE A",
            "city": "NORMAN",
            "state": "OK",
            "postal_code": "730694033",
            "telephone_number": "405-701-3733",
            "fax_number": "405-701-3752"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2202 WESTPARK DR",
            "address_2": "SUITE A",
            "city": "NORMAN",
            "state": "OK",
            "postal_code": "730694033",
            "telephone_number": "405-701-3733",
            "fax_number": "405-701-3752"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ETHERIDGE PROSTHETICS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-06-23",
        "last_updated": "2015-11-20",
        "status": "A",
        "authorized_official_last_name": "ETHERIDGE",
        "authorized_official_first_name": "WILLIAM",
        "authorized_official_middle_name": "ROBERT",
        "authorized_official_title_or_position": "PROSTHETIST",
        "authorized_official_telephone_number": "405-323-6936",
        "authorized_official_credential": "BOCP LP"
    },
    "taxonomies": [
        {
            "code": "224P00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Prosthetist",
            "state": "OK",
            "license": "C21410",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Mykah Jo Eshbaugh, SLP
• Megan Heatly Eskridge, MPT
• Vanessa Esparza
• Essence Aesthetics, LLC
• Autumn D Estes
• William Robert Etheridge, BOC LP
• Hailey Marie Eurto
• Zoe Grey Evalds
• Evan W Luttrell Aprn-Crna PC
• Melissa Marie Evans-Brave, D.O

• Prosthetist in Norman, OK
• Providers in Norman, OK by specialty
• Prosthetist in Oklahoma

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 20, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.