Davidson Prosthetics LLC

Primary specialty

Prosthetic/Orthotic SupplierTaxonomy code 335E00000X

License

CPO01874 Issued in WA

Legal business name

DAVIDSON PROSTHETICS LLC

Practice address

11919 Canyon Rd E
Puyallup, WA 98373-4456

Phone

(253) 770-6578

Fax

(253) 881-1397

NPI assigned

Oct 3, 2008

Organization subpart

No

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

Authorized official

Name

Greg E Davidson, CPO

Title

Owner

Phone

(253) 651-8250

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in WA

Enrollment records 1

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

• Greg E Davidson, CPO

  • Specialist
  • Puyallup, WA
  • NPI 1639218829

  O20100930086749

  Same enrollment

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.

• Nathan E Davidson, LCPO

  • Specialist
  • Puyallup, WA
  • NPI 1679763247
  NPD (past)

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

{
    "created_epoch": "1222992000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1658361600000",
    "number": "1033360409",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11919 CANYON RD E",
            "city": "PUYALLUP",
            "state": "WA",
            "postal_code": "983734456",
            "telephone_number": "253-770-6578",
            "fax_number": "253-881-1397"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11919 CANYON RD E",
            "city": "PUYALLUP",
            "state": "WA",
            "postal_code": "983734456",
            "telephone_number": "253-770-6578",
            "fax_number": "253-881-1397"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DAVIDSON PROSTHETICS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-10-03",
        "last_updated": "2022-07-21",
        "status": "A",
        "authorized_official_last_name": "DAVIDSON",
        "authorized_official_first_name": "GREG",
        "authorized_official_middle_name": "E",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "253-651-8250",
        "authorized_official_credential": "CPO"
    },
    "taxonomies": [
        {
            "code": "335E00000X",
            "taxonomy_group": "",
            "desc": "Prosthetic/Orthotic Supplier",
            "state": "WA",
            "license": "CPO01874",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "9062993",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jessica Darnell, LMP
• Stephanie Daugherty, DPT
• Tobias Dean Daugherty
• Erin Ashley Dautremont, DO
• Rachelle David
• David Alan Davidson, MD
• Greg E Davidson, CPO
• Jessica Lara Davidson, LMT
• Katherine Juarez Davidson
• Lawrence Davidson IV, LMT

• Prosthetic/Orthotic Supplier in Puyallup, WA
• Providers in Puyallup, WA by specialty
• Prosthetic/Orthotic Supplier in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; 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.