Provider Demographics
NPI:1306018171
Name:NORTHBAY PROSTHETICS AND ORTHOTICS LLC
Entity type:Organization
Organization Name:NORTHBAY PROSTHETICS AND ORTHOTICS LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:BRIGHT
Authorized Official - Suffix:
Authorized Official - Credentials:CPO
Authorized Official - Phone:707-245-7010
Mailing Address - Street 1:PO BOX 908
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:94533-0090
Mailing Address - Country:US
Mailing Address - Phone:707-425-5028
Mailing Address - Fax:
Practice Address - Street 1:3260 BEARD RD
Practice Address - Street 2:SUITE 3
Practice Address - City:NAPA
Practice Address - State:CA
Practice Address - Zip Code:94558-3423
Practice Address - Country:US
Practice Address - Phone:707-254-7010
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-01
Last Update Date:2008-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier