Provider Demographics
NPI:1306133186
Name:ULTIMATE ATHLETIC EQUIPMENT
Entity type:Organization
Organization Name:ULTIMATE ATHLETIC EQUIPMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:RAMONED
Authorized Official - Middle Name:TEREZE
Authorized Official - Last Name:MORROW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:800-548-8806
Mailing Address - Street 1:286 KENWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70806-4519
Mailing Address - Country:US
Mailing Address - Phone:800-548-8806
Mailing Address - Fax:
Practice Address - Street 1:286 KENWOOD AVE
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70806-4519
Practice Address - Country:US
Practice Address - Phone:800-548-8806
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-30
Last Update Date:2011-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA00884900335E00000X
335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier