Provider Demographics
NPI:1215048640
Name:HANGER PROSTHETICS & ORTHOTICS EAST, INC
Entity type:Organization
Organization Name:HANGER PROSTHETICS & ORTHOTICS EAST, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:REG COMPLIANCE SPECIALIST III
Authorized Official - Prefix:
Authorized Official - First Name:GRACE
Authorized Official - Middle Name:
Authorized Official - Last Name:ANGELINE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:714-961-2102
Mailing Address - Street 1:4155 E LA PALMA AVE STE B400
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92807-1857
Mailing Address - Country:US
Mailing Address - Phone:714-961-2102
Mailing Address - Fax:
Practice Address - Street 1:3500 S 79TH ST STE A
Practice Address - Street 2:
Practice Address - City:FORT SMITH
Practice Address - State:AR
Practice Address - Zip Code:72903-6250
Practice Address - Country:US
Practice Address - Phone:479-484-1620
Practice Address - Fax:479-484-1619
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HANGER INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-08-31
Last Update Date:2020-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100794930WMedicaid
AR155003716Medicaid
0339460313Medicare NSC