Provider Demographics
NPI:1881100584
Name:ANCHOR ORTHOTICS AND PROSTHETICS, INC.
Entity type:Organization
Organization Name:ANCHOR ORTHOTICS AND PROSTHETICS, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TERRENCE
Authorized Official - Middle Name:
Authorized Official - Last Name:MCDONALD
Authorized Official - Suffix:
Authorized Official - Credentials:CO
Authorized Official - Phone:916-484-0685
Mailing Address - Street 1:PO BOX 300
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:CA
Mailing Address - Zip Code:95604-0300
Mailing Address - Country:US
Mailing Address - Phone:650-364-3088
Mailing Address - Fax:650-364-3097
Practice Address - Street 1:617 VETERANS BLVD STE 101
Practice Address - Street 2:
Practice Address - City:REDWOOD CITY
Practice Address - State:CA
Practice Address - Zip Code:94063-1404
Practice Address - Country:US
Practice Address - Phone:650-364-3088
Practice Address - Fax:650-364-3097
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-12-18
Last Update Date:2017-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGXC000890Medicaid