Basic Information
| Provider Information | |||||||||
| NPI: | 1235287830 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | HATTINGH HOLDINGS INC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | NORTHWEST PROSTHETIC & ORTHOTIC CLINIC | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 600 BROADWAY | ||||||||
| Address2: | SUITE 190 | ||||||||
| City: | SEATTLE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 981225395 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2063234040 | ||||||||
| FaxNumber: | 2063240943 | ||||||||
| Practice Location | |||||||||
| Address1: | 2625 WHEATON WAY | ||||||||
| Address2: | SUITE B | ||||||||
| City: | BREMERTON | ||||||||
| State: | WA | ||||||||
| PostalCode: | 983103371 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3604056976 | ||||||||
| FaxNumber: | 3604791885 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/08/2007 | ||||||||
| LastUpdateDate: | 10/22/2008 | ||||||||
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| AuthorizedOfficialLastName: | HATTINGH | ||||||||
| AuthorizedOfficialFirstName: | JOHN | ||||||||
| AuthorizedOfficialMiddleName: | H | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 2063234040 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | CPO | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 335E00000X | WA | Y | Suppliers | Prosthetic/Orthotic Supplier |
ID Information
| ID | Type | State | Issuer | Description | 9036963 | 05 | WA | MEDICAID |