NPIMap

Organization Active NPI

Pro-Tech Sports Medicine, Inc.

  • Prosthetic/Orthotic Supplier
  • Lake Oswego, OR
National Provider Identifier
1992721294
Registry record updated Oct 29, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Prosthetic/Orthotic SupplierTaxonomy code 335E00000X
Legal business name
PRO-TECH SPORTS MEDICINE, INC.
Practice address
16679 Boones Ferry Rd
Suite 215
Lake Oswego, OR 97035-4365
Phone
(503) 699-0045
Fax
(503) 699-1911
NPI assigned
Jul 14, 2006
Last updated
Oct 29, 2008By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 29, 2008

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

Authorized official

Name
Mr. John Gregory, C.O.
Title
Owner
Phone
(503) 699-0045

Specialties & licenses 1

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

Addresses

Primary practice location

16679 Boones Ferry Rd
Suite 215
Lake Oswego, OR 97035-4365

Mailing address

16679 Boones Ferry Rd
Suite 215
Lake Oswego, OR 97035-4365
Phone (503) 699-0045

Other identifiers 2

IdentifierTypeStateIssuer
035985MedicaidOR
081911000OtherORBLUE CROSS PROVIDER #

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1152835200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1225238400000",
    "number": "1992721294",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "16679 BOONES FERRY RD",
            "address_2": "SUITE 215",
            "city": "LAKE OSWEGO",
            "state": "OR",
            "postal_code": "970354365",
            "telephone_number": "503-699-0045",
            "fax_number": "503-699-1911"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "16679 BOONES FERRY RD",
            "address_2": "SUITE 215",
            "city": "LAKE OSWEGO",
            "state": "OR",
            "postal_code": "970354365",
            "telephone_number": "503-699-0045",
            "fax_number": "503-699-1911"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRO-TECH SPORTS MEDICINE, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-14",
        "last_updated": "2008-10-29",
        "status": "A",
        "authorized_official_last_name": "GREGORY",
        "authorized_official_first_name": "JOHN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "503-699-0045",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "C.O."
    },
    "taxonomies": [
        {
            "code": "335E00000X",
            "taxonomy_group": "",
            "desc": "Prosthetic/Orthotic Supplier",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "035985",
            "state": "OR"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS PROVIDER #",
            "identifier": "081911000",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Lake Oswego, OR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 29, 2008; 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.