Active NPI
Clearwater Orthotics and Prosthetics, LLC
- Prosthetic/Orthotic Supplier
- Lewiston, ID
National Provider Identifier
1285852004
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Prosthetic/Orthotic Supplier
- Legal business name
- CLEARWATER ORTHOTICS AND PROSTHETICS, LLC
- Practice address
- 801 Bryden Ave
Lewiston, ID 83501-4927 - Phone
- (208) 798-4605
- NPI assigned
- Apr 24, 2007
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Karen Hale
- Title
- Office Manager
- Phone
- (818) 357-5732
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Prosthetic/Orthotic Supplier | 335E00000X | Primary |
Addresses
Primary practice location
801 Bryden Ave
Lewiston, ID 83501-4927
Mailing address
PO Box 2620
Hayden, ID 83835-2620
Other identifiers 5
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 805399000 | Medicaid | ID | |
| 9047259 | Medicaid | WA | |
| 000010028073 | Other | ID | REGENCE BLUE SHIELD OF ID |
| 135273 | Other | WA | L&I |
| 8M820 | Other | ID | BLUE CROSS OF IDAHO |
National Provider Directory
National Provider DirectoryLocations
801 Bryden Ave
Lewiston, ID 83501
Phone (208) 798-4605
Practitioners & affiliated clinicians
Practitioners 1
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1177372800000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1322697600000",
"number": "1285852004",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 2620",
"city": "HAYDEN",
"state": "ID",
"postal_code": "838352620"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "801 BRYDEN AVE",
"city": "LEWISTON",
"state": "ID",
"postal_code": "835014927",
"telephone_number": "208-798-4605"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "CLEARWATER ORTHOTICS AND PROSTHETICS, LLC",
"organizational_subpart": "NO",
"enumeration_date": "2007-04-24",
"last_updated": "2011-12-01",
"status": "A",
"authorized_official_last_name": "HALE",
"authorized_official_first_name": "KAREN",
"authorized_official_title_or_position": "OFFICE MANAGER",
"authorized_official_telephone_number": "818-357-5732"
},
"taxonomies": [
{
"code": "335E00000X",
"taxonomy_group": "",
"desc": "Prosthetic/Orthotic Supplier",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "805399000",
"state": "ID"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "9047259",
"state": "WA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "REGENCE BLUE SHIELD OF ID",
"identifier": "000010028073",
"state": "ID"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "L&I",
"identifier": "135273",
"state": "WA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS OF IDAHO",
"identifier": "8M820",
"state": "ID"
}
],
"endpoints": [],
"other_names": []
}Other providers in Lewiston, ID
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 1, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.