Provider Demographics
NPI:1063908358
Name:CAPSTONE ORTHOPEDIC, INC
Entity type:Organization
Organization Name:CAPSTONE ORTHOPEDIC, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:GLEN
Authorized Official - Middle Name:STEPHEN
Authorized Official - Last Name:ELLIS
Authorized Official - Suffix:
Authorized Official - Credentials:CPO
Authorized Official - Phone:510-537-1210
Mailing Address - Street 1:1011 CASS ST STE 112
Mailing Address - Street 2:
Mailing Address - City:MONTEREY
Mailing Address - State:CA
Mailing Address - Zip Code:93940-4542
Mailing Address - Country:US
Mailing Address - Phone:831-375-2300
Mailing Address - Fax:831-375-2400
Practice Address - Street 1:1011 CASS ST STE 112
Practice Address - Street 2:
Practice Address - City:MONTEREY
Practice Address - State:CA
Practice Address - Zip Code:93940-4542
Practice Address - Country:US
Practice Address - Phone:831-375-2300
Practice Address - Fax:831-375-2400
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CAPSTONE ORTHOPEDIC, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-07-10
Last Update Date:2018-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier