Basic Information
| Provider Information | |||||||||
| NPI: | 1003911702 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | HANGER PROSTHETICS & ORTHOTICS WEST, INC. | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | HANGER CLNIC | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 650846 | ||||||||
| Address2: | |||||||||
| City: | DALLAS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 752650846 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2063234040 | ||||||||
| FaxNumber: | 2066254741 | ||||||||
| Practice Location | |||||||||
| Address1: | 1101 MADISON ST STE 550 | ||||||||
| Address2: | |||||||||
| City: | SEATTLE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 981041320 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2063234040 | ||||||||
| FaxNumber: | 2066254741 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/14/2006 | ||||||||
| LastUpdateDate: | 08/12/2020 | ||||||||
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| AuthorizedOfficialLastName: | ANGELINE | ||||||||
| AuthorizedOfficialFirstName: | GRACE | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | REG COMPLIANCE SPECIALIST III | ||||||||
| AuthorizedOfficialTelephone: | 7149612102 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | HANGER INC | ||||||||
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| NPICertificationDate: | 08/12/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 332B00000X | N | Suppliers | Durable Medical Equipment & Medical Supplies | 335E00000X | Y | Suppliers | Prosthetic/Orthotic Supplier |
No ID Information.