NPIMap

Organization Active NPI

Tammy L Dirksen

  • Prosthetic/Orthotic Supplier
  • Fresno, CA
National Provider Identifier
1558559484
Registry record updated Jul 12, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Prosthetic/Orthotic SupplierTaxonomy code 335E00000X
Legal business name
TAMMY L DIRKSEN
Doing business as
CENTRAL ORTHOTIC & PROSTHETIC
Practice address
2039 N Fine Ave
Fresno, CA 93727-1512
Phone
(559) 251-5557
Fax
(559) 251-5559
NPI assigned
Oct 4, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 12, 2022

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

Authorized official

Name
Tammy Dirksen, CONPI 1366621567
Title
Owner
Phone
(559) 251-5557

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Prosthetic/Orthotic Supplier 335E00000X Primary

Addresses

Primary practice location

2039 N Fine Ave
Fresno, CA 93727-1512

Mailing address

2039 N Fine Ave
Fresno, CA 93727-1512
Phone (559) 251-5557

Other identifiers 1

IdentifierTypeStateIssuer
GXC000650MedicaidCA

Other names 1

  • CENTRAL ORTHOTIC & PROSTHETIC Doing business as

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 3

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": "1191456000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1657584000000",
    "number": "1558559484",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2039 N FINE AVE",
            "city": "FRESNO",
            "state": "CA",
            "postal_code": "937271512",
            "telephone_number": "559-251-5557",
            "fax_number": "559-251-5559"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2039 N FINE AVE",
            "city": "FRESNO",
            "state": "CA",
            "postal_code": "937271512",
            "telephone_number": "559-251-5557",
            "fax_number": "559-251-5559"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TAMMY L DIRKSEN",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-10-04",
        "last_updated": "2022-07-12",
        "certification_date": "2022-07-06",
        "status": "A",
        "authorized_official_last_name": "DIRKSEN",
        "authorized_official_first_name": "TAMMY",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "559-251-5557",
        "authorized_official_credential": "CO"
    },
    "taxonomies": [
        {
            "code": "335E00000X",
            "taxonomy_group": "",
            "desc": "Prosthetic/Orthotic Supplier",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GXC000650",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "CENTRAL ORTHOTIC & PROSTHETIC",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "CENTRAL ORTHOTIC & PROSTHETIC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Fresno, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 12, 2022; 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.