Idaho Orthotic Prosthetic Services, Inc

Primary specialty

Prosthetic/Orthotic SupplierTaxonomy code 335E00000X

Legal business name

IDAHO ORTHOTIC PROSTHETIC SERVICES, INC

Practice address

425 S Whitley Dr Ste 431
Fruitland, ID 83619-2611

Phone

(208) 884-1294

Fax

(208) 884-1293

NPI assigned

Jan 26, 2007

Organization subpart

No

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

Authorized official

Name

Diana K Morrison

Title

Contract Specialist

Phone

(503) 765-5081

Specialties & licenses 1

Addresses

Other identifiers 5

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

{
    "created_epoch": "1169769600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1593475200000",
    "number": "1801942354",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8880 SW NIMBUS AVE STE A",
            "city": "BEAVERTON",
            "state": "OR",
            "postal_code": "970087111",
            "telephone_number": "503-765-5081",
            "fax_number": "503-765-5081"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "425 S WHITLEY DR STE 431",
            "city": "FRUITLAND",
            "state": "ID",
            "postal_code": "836192611",
            "telephone_number": "208-884-1294",
            "fax_number": "208-884-1293"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "IDAHO ORTHOTIC PROSTHETIC SERVICES, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-26",
        "last_updated": "2020-06-30",
        "certification_date": "2020-06-30",
        "status": "A",
        "authorized_official_last_name": "MORRISON",
        "authorized_official_first_name": "DIANA",
        "authorized_official_middle_name": "K",
        "authorized_official_title_or_position": "CONTRACT SPECIALIST",
        "authorized_official_telephone_number": "503-765-5081"
    },
    "taxonomies": [
        {
            "code": "335E00000X",
            "taxonomy_group": "",
            "desc": "Prosthetic/Orthotic Supplier",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD IDAHO",
            "identifier": "000010148826",
            "state": "ID"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TRUE BLUE BLUE CROSS IDAH",
            "identifier": "8K537",
            "state": "ID"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "807031400",
            "state": "ID"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "277882",
            "state": "OR"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS IDAHO",
            "identifier": "8K537",
            "state": "ID"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Prosthetic/Orthotic Supplier in Fruitland, ID
• Providers in Fruitland, ID by specialty
• Prosthetic/Orthotic Supplier in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 30, 2020; 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.