Provider Demographics
NPI:1215168398
Name:MAUGHAN PROSTHETIC & ORTHOTIC, INC.
Entity type:Organization
Organization Name:MAUGHAN PROSTHETIC & ORTHOTIC, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CPO
Authorized Official - Prefix:MR
Authorized Official - First Name:JUSTIN
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:MAUGHAN
Authorized Official - Suffix:I
Authorized Official - Credentials:CPO
Authorized Official - Phone:253-820-3689
Mailing Address - Street 1:PO BOX 1546
Mailing Address - Street 2:
Mailing Address - City:GRAHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98338-1546
Mailing Address - Country:US
Mailing Address - Phone:360-447-0770
Mailing Address - Fax:253-904-8705
Practice Address - Street 1:10689 OLD FRONTIER RD NW STE 201
Practice Address - Street 2:
Practice Address - City:SILVERDALE
Practice Address - State:WA
Practice Address - Zip Code:98383-9040
Practice Address - Country:US
Practice Address - Phone:360-698-2229
Practice Address - Fax:360-698-0122
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-06
Last Update Date:2024-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPS00000183335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA6307470001Medicare NSC