Medsource Orthotics & Prosthetics, Inc

Primary specialty

Prosthetic/Orthotic SupplierTaxonomy code 335E00000X

License

21067439 Issued in AZ

Legal business name

MEDSOURCE ORTHOTICS & PROSTHETICS, INC

Doing business as

Hamilton Prosthetics

Practice address

1450 S Dobson Rd Ste B326
Mesa, AZ 85202

Phone

(602) 395-3354

Fax

(888) 828-8290

NPI assigned

Jun 18, 2018

Last updated

Sep 14, 2018By 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

David Charles

Title

President

Phone

(801) 255-5202

Specialties & licenses 1

Addresses

Other names 1

• Hamilton Prosthetics Doing business as

Locations

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

{
    "created_epoch": "1529280000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1536883200000",
    "number": "1245724822",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3636 N 3RD AVE STE 100",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850133938",
            "telephone_number": "602-395-3358",
            "fax_number": "888-828-8290"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1450 S DOBSON RD STE B326",
            "city": "MESA",
            "state": "AZ",
            "postal_code": "85202",
            "telephone_number": "602-395-3354",
            "fax_number": "888-828-8290"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MEDSOURCE ORTHOTICS & PROSTHETICS, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-06-18",
        "last_updated": "2018-09-14",
        "status": "A",
        "authorized_official_last_name": "CHARLES",
        "authorized_official_first_name": "DAVID",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "801-255-5202"
    },
    "taxonomies": [
        {
            "code": "335E00000X",
            "taxonomy_group": "",
            "desc": "Prosthetic/Orthotic Supplier",
            "state": "AZ",
            "license": "21067439",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Hamilton Prosthetics",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Prosthetic/Orthotic Supplier in Mesa, AZ
• Providers in Mesa, AZ by specialty
• Prosthetic/Orthotic Supplier in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 14, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.