Island Prosthetics & Orthotics, Inc.

Primary specialty

Prosthetic/Orthotic SupplierTaxonomy code 335E00000X

License

602433234 Issued in WA

Legal business name

ISLAND PROSTHETICS & ORTHOTICS, INC.

Practice address

80 N. Main St
Suite C
Coupeville, WA 98239

Phone

(360) 678-4700

Fax

(360) 678-4711

NPI assigned

May 10, 2006

Organization subpart

No

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

Authorized official

Name

Mr. David E. Mathews, LCP

Title

Owner

Phone

(360) 678-4700

Specialties & licenses 1

Addresses

Other identifiers 3

Medicare fee-for-service enrollment

Enrolled in WA

Enrollment records 1

Locations

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

{
    "created_epoch": "1147219200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1332720000000",
    "number": "1821048034",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6921 HIGH POINT DR",
            "city": "CLINTON",
            "state": "WA",
            "postal_code": "982368702",
            "telephone_number": "360-678-4700",
            "fax_number": "360-678-4711"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "80 N. MAIN ST",
            "address_2": "SUITE C",
            "city": "COUPEVILLE",
            "state": "WA",
            "postal_code": "98239",
            "telephone_number": "360-678-4700",
            "fax_number": "360-678-4711"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ISLAND PROSTHETICS & ORTHOTICS, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-10",
        "last_updated": "2012-03-26",
        "status": "A",
        "authorized_official_last_name": "MATHEWS",
        "authorized_official_first_name": "DAVID",
        "authorized_official_middle_name": "E.",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "360-678-4700",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "LCP"
    },
    "taxonomies": [
        {
            "code": "335E00000X",
            "taxonomy_group": "",
            "desc": "Prosthetic/Orthotic Supplier",
            "state": "WA",
            "license": "602433234",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LABOR & INDUSTRIES, WA",
            "identifier": "0143888",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "REGENCE BLUE SHIELD",
            "identifier": "5780IS",
            "state": "WA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "9052986",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Maryann Holden
• Benjamin T Hu, MD
• Island County Dermatology PLLC
• Island County Ultrasound
• Island Facial Aesthetics P.S.
• J Chalice Bailey LMFT CCTP PLLC
• Ellen Augustine Jacus, PA-C
• Rida Jamal, M.D.
• Janet E Colli PHD PLLC
• Kristine Liane Jarrell, AUD

• Prosthetic/Orthotic Supplier in Coupeville, WA
• Providers in Coupeville, WA by specialty
• Prosthetic/Orthotic Supplier in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 26, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.