Peterson Performance Products Inc

Primary specialty

Customized Equipment (DME)Taxonomy code 332BC3200X

License

C15236 Issued in OR

Legal business name

PETERSON PERFORMANCE PRODUCTS INC

Doing business as

Peterson's Orthotic Lab

Practice address

900 SE Wilson Ave
Suite F
Bend, OR 97702-1416

Phone

(541) 647-1108

Fax

(541) 647-2162

NPI assigned

Jun 21, 2011

Last updated

Jun 21, 2011By 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. Scott William Peterson, C. PED., C. O.

Title

President

Phone

(541) 647-1108

Specialties & licenses 1

Addresses

Other names 1

• Peterson's Orthotic Lab Doing business as

Tax ID family

Foot Fitness2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Peterson Performance Products, Inc.

  dba Foot Fitness

  • Durable Medical Equipment & Medical Supplies
  • Bend, OR
  • NPI 1003856816
  NPD tax ID

Locations

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

{
    "created_epoch": "1308614400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1308614400000",
    "number": "1568758282",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "900 SE WILSON AVE",
            "address_2": "SUITE F",
            "city": "BEND",
            "state": "OR",
            "postal_code": "977021416",
            "telephone_number": "541-647-1108",
            "fax_number": "541-647-2162"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "900 SE WILSON AVE",
            "address_2": "SUITE F",
            "city": "BEND",
            "state": "OR",
            "postal_code": "977021416",
            "telephone_number": "541-647-1108",
            "fax_number": "541-647-2162"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PETERSON PERFORMANCE PRODUCTS INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-06-21",
        "last_updated": "2011-06-21",
        "status": "A",
        "authorized_official_last_name": "PETERSON",
        "authorized_official_first_name": "SCOTT",
        "authorized_official_middle_name": "WILLIAM",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "541-647-1108",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "C. PED., C. O."
    },
    "taxonomies": [
        {
            "code": "332BC3200X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies, Customized Equipment",
            "state": "OR",
            "license": "C15236",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Peterson's Orthotic Lab",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Peters Dermatology Center
• Daisha Marie Peters
• Gerald E Peters Jr., M.D.
• Emily Petersen
• Kiana Kay Shin-Tze Petersen
• Peterson Performance Products, Inc. (Foot Fitness)
• Jake Allen Peterson, DDS, MD
• Jessica Peterson
• Jodi Peterson
• Johanna Rae Peterson, PA-C

• Customized Equipment (DME) in Bend, OR
• Providers in Bend, OR by specialty
• Customized Equipment (DME) in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 21, 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.

Verify at the official NPI Registry.