Orthopro of Lewiston Inc

Primary specialty

Prosthetic/Orthotic SupplierTaxonomy code 335E00000X

Legal business name

ORTHOPRO OF LEWISTON INC

Practice address

823 16TH Ave
Lewiston, ID 83501-3733

Phone

(208) 798-0200

Fax

(208) 798-0201

NPI assigned

Nov 21, 2007

Last updated

Sep 27, 2016By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mr. Marshall R Black, CPONPI 1154357242

Title

Owner

Phone

(208) 798-0200

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in ID

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, and the practitioner matching its NPPES authorized official.

• Marshall R Black, CPO

  • Orthotist
  • Lewiston, ID
  • NPI 1154357242
  NPD (past) Authorized official

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

{
    "created_epoch": "1195603200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1474934400000",
    "number": "1124209820",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "823 16TH AVE",
            "city": "LEWISTON",
            "state": "ID",
            "postal_code": "835013733",
            "telephone_number": "208-798-0200",
            "fax_number": "208-798-0201"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "823 16TH AVE",
            "city": "LEWISTON",
            "state": "ID",
            "postal_code": "835013733",
            "telephone_number": "208-798-0200",
            "fax_number": "208-798-0201"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ORTHOPRO OF LEWISTON INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-11-21",
        "last_updated": "2016-09-27",
        "status": "A",
        "authorized_official_last_name": "BLACK",
        "authorized_official_first_name": "MARSHALL",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "208-798-0200",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "CPO"
    },
    "taxonomies": [
        {
            "code": "335E00000X",
            "taxonomy_group": "",
            "desc": "Prosthetic/Orthotic Supplier",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Prosthetic/Orthotic Supplier in Lewiston, ID
• Providers in Lewiston, ID by specialty
• Prosthetic/Orthotic Supplier in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 27, 2016; 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.