NPIMap

Organization Active NPI

Munger Prosthetics and Orthotics, Inc.

  • Prosthetic/Orthotic Supplier
  • Wasilla, AK
National Provider Identifier
1821346065
Registry record updated Aug 20, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Prosthetic/Orthotic SupplierTaxonomy code 335E00000X
License
CPO01700 Issued in DE
Legal business name
MUNGER PROSTHETICS AND ORTHOTICS, INC.
Practice address
1700 E Bogard Rd
#104 Building B
Wasilla, AK 99654-6563
Phone
(907) 743-9991
Fax
(907) 743-9992
NPI assigned
Aug 20, 2012
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 20, 2012

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

Authorized official

Name
Mr. Trevor D Munger, CPONPI 1962761973
Title
President/Practitioner
Phone
(907) 743-9991

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 CPO01700 DE Primary

Addresses

Primary practice location

1700 E Bogard Rd
#104 Building B
Wasilla, AK 99654-6563

Mailing address

5701 Lake Otis Pkwy Ste 400
Anchorage, AK 99507-1778
Phone (907) 743-9991

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AK

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20121022000388 AK DME Supplier - Certified Orth/Pros/Pedorthist 1052513389 Practice locations: Wasilla, AK

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

National Provider Directory

National Provider Directory
Tax ID family
Munger Prosthetics and Orthotics Inc2 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.

Locations

1700 E Bogard Rd
Ste B104
Wasilla, AK 99654
Phone (907) 743-9991

Practitioners & affiliated clinicians

Practitioners 1

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": "1345420800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1345420800000",
    "number": "1821346065",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5701 LAKE OTIS PKWY STE 400",
            "city": "ANCHORAGE",
            "state": "AK",
            "postal_code": "995071778",
            "telephone_number": "907-743-9991",
            "fax_number": "907-743-9992"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1700 E BOGARD RD",
            "address_2": "#104 BUILDING B",
            "city": "WASILLA",
            "state": "AK",
            "postal_code": "996546563",
            "telephone_number": "907-743-9991",
            "fax_number": "907-743-9992"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MUNGER PROSTHETICS AND ORTHOTICS, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-08-20",
        "last_updated": "2012-08-20",
        "status": "A",
        "authorized_official_last_name": "MUNGER",
        "authorized_official_first_name": "TREVOR",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "PRESIDENT/PRACTITIONER",
        "authorized_official_telephone_number": "907-743-9991",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "CPO"
    },
    "taxonomies": [
        {
            "code": "335E00000X",
            "taxonomy_group": "",
            "desc": "Prosthetic/Orthotic Supplier",
            "state": "DE",
            "license": "CPO01700",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Wasilla, AK

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 20, 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.