Provider Demographics
NPI:1447551601
Name:PLATINUM INNOVATIONS, LTD.
Entity type:Organization
Organization Name:PLATINUM INNOVATIONS, LTD.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CERTIFIED PEDORTHIST
Authorized Official - Prefix:MR
Authorized Official - First Name:MARC
Authorized Official - Middle Name:
Authorized Official - Last Name:WEISS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:210-615-0004
Mailing Address - Street 1:2039 TRAWOOD DR
Mailing Address - Street 2:STE B
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79935-3501
Mailing Address - Country:US
Mailing Address - Phone:915-546-5171
Mailing Address - Fax:915-546-9774
Practice Address - Street 1:2039 TRAWOOD DR
Practice Address - Street 2:STE B
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79935-3501
Practice Address - Country:US
Practice Address - Phone:915-546-5171
Practice Address - Fax:915-546-9774
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PLATINUM INNOVATIONS, LTD.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-11-04
Last Update Date:2012-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1598054-01Medicaid
TX4739540002Medicare NSC