Provider Demographics
NPI:1063728707
Name:YAKIMA ORTHOTICS AND PROSTHETICS, PC
Entity type:Organization
Organization Name:YAKIMA ORTHOTICS AND PROSTHETICS, PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:D
Authorized Official - Last Name:LAMBERT
Authorized Official - Suffix:
Authorized Official - Credentials:CPO
Authorized Official - Phone:509-248-8040
Mailing Address - Street 1:313 S 9TH AVE
Mailing Address - Street 2:
Mailing Address - City:YAKIMA
Mailing Address - State:WA
Mailing Address - Zip Code:98902-3516
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1206 N DOLARWAY RD
Practice Address - Street 2:SUITE 110
Practice Address - City:ELLENSBURG
Practice Address - State:WA
Practice Address - Zip Code:98926-8392
Practice Address - Country:US
Practice Address - Phone:509-925-7700
Practice Address - Fax:509-925-7707
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-19
Last Update Date:2017-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA602349936335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA120244OtherLABOR AND INDUSTRIES
WAW40472OtherCHAMPUS TRICARE
WAYA0282OtherPREMERA BLUE CROSS
WA9045675Medicaid
WAYA0282OtherREGENCE BLUE SHIELD
WA9045675Medicaid