Advanced Prosthetics and Orthotics LLC
Organization Active NPI Prosthetic/Orthotic Supplier · Meridian, ID
NPI 1346717899 · NPPES record last updated Dec 17, 2025
Key facts
- NPI
- 1346717899
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Prosthetic/Orthotic Supplier 335E00000X
- Legal business name
- ADVANCED PROSTHETICS AND ORTHOTICS LLC
- Practice address
- 904 S Vanguard Way Ste 100
Meridian, ID 83642-7552 - Phone
- (208) 466-4360
- Fax
- (844) 274-2789
- NPI assigned
- Nov 1, 2018
- Organization subpart
- No
Authorized official
- Name
- Mrs. Stephanie Walker McDonald
- Title
- Owner
- Phone
- (208) 985-5190
Other NPIs with the same Medicare PAC ID 1
Laboratory certificates & supplier records
Medicare medical equipment & supply locations
| Supplier | Supplies | Medicare assignment |
|---|---|---|
| Advanced Prosthetics and Orthotics |
Orthoses: Custom Fabricated|Orthoses: Prefabricated (Non-Custom Fabricated)|Orthoses: Off-The-Shelf|Limb Prostheses|Diabetic Shoes and Inserts|Diabetic Shoes/Inserts - Custom | Does not accept assignment |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in ID
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20190514000708 | ID | DME Supplier - Orthotic Personnel |
0244573301 | Practice locations: Meridian, ID |
National Provider Directory
Locations
175 N Benjamin Ln
Boise, ID 83704
Phone (208) 377-4024
904 S Vanguard Way
#100
Meridian, ID 83642
Phone (208) 377-4024
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Durable Medical Equipment & Medical Supplies | 332B00000X | |||
| Prosthetic/Orthotic Supplier | 335E00000X | Yes |
Addresses
Primary practice location
904 S Vanguard Way Ste 100
Meridian, ID 83642-7552
Mailing address
904 S Vanguard Way Ste 100
Meridian, ID 83642-7552
Phone (208) 466-4360
Other names
- Kormylo Orthopedic
Other providers in Meridian, ID
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- Advanced Illness Management
- Advanced Medical Center
- Advanced Open Imaging Boise LLC
- Advanced Pain Management PLLC
- Advanced PT LLC
- Advantage Dental Center
- Aegis Group Practice LLC
- Aesthetic Smiles
- Aesthetic Smiles P LLC
All providers in Meridian, ID · Prosthetic/Orthotic Supplier in Idaho
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 17, 2025. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.