NPIViewer - Provider NPI 1386643856

NPI:	1386643856
Name:	DYNASPLINT SYSTEMS, INC
Entity type:	Organization
Organization Name:	DYNASPLINT SYSTEMS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:	PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:	GEORGE
Authorized Official - Middle Name:	R
Authorized Official - Last Name:	HEPBURN
Authorized Official - Suffix:
Authorized Official - Credentials:	PT
Authorized Official - Phone:	800-638-6771
Mailing Address - Street 1:	770 RITCHIE HIGHWAY
Mailing Address - Street 2:	SUITE W-21
Mailing Address - City:	SEVERNA PARK
Mailing Address - State:	MD
Mailing Address - Zip Code:	21146-4152
Mailing Address - Country:	US
Mailing Address - Phone:	800-638-6771
Mailing Address - Fax:	800-380-3784
Practice Address - Street 1:	770 RITCHIE HIGHWAY
Practice Address - Street 2:	SUITE W-21
Practice Address - City:	SEVERNA PARK
Practice Address - State:	MD
Practice Address - Zip Code:	21146-4152
Practice Address - Country:	US
Practice Address - Phone:	800-638-6771
Practice Address - Fax:	800-380-3784
EIN:	<UNAVAIL>
Is Organization Subpart?:	No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:	2005-07-18
Last Update Date:	2022-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:

State	License ID	Taxonomies
MD	1121034	332B00000X, 335E00000X

Primary?	Code	Type	Classification	Specialization
Yes	332B00000X	Suppliers	Durable Medical Equipment & Medical Supplies
No	335E00000X	Suppliers	Prosthetic/Orthotic Supplier

State	Identifier ID	ID Type
IL	---------002	Medicaid
PA	0015125780004	Medicaid
KS	200378120A	Medicaid
CT	3088748	Medicaid
WV	9800010000	Medicaid
MS	00440443	Medicaid
NV	100503478	Medicaid
MD	258948600	Medicaid
KY	90092396	Medicaid
NM	000F4585	Medicaid
TX	0872541-02	Medicaid
WI	81023300	Medicaid
AK	MS53MD	Medicaid
NE	---------00	Medicaid
RI	0253470	Medicaid
OH	0689189	Medicaid
DE	1000040699	Medicaid
VA	1386643856	Medicaid
OR	213193	Medicaid
OK	100798260A	Medicaid
MN	1386643856	Medicaid
MA	1534408	Medicaid
NH	30006453	Medicaid
ID	001478600	Medicaid
TX	0872541-03	Medicaid
IA	1386643856	Medicaid
CO	88307514	Medicaid
TX	0872541-01	Medicaid
IN	100011170A	Medicaid
GA	349463790A	Medicaid
WA	9048935	Medicaid
SC	DM0524	Medicaid
DE	1000040699	Medicaid