Provider Demographics
NPI:1811297583
Name:ORIGINAL ORTHO BACK-UP, LLC
Entity type:Organization
Organization Name:ORIGINAL ORTHO BACK-UP, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:
Authorized Official - Last Name:RITTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:877-756-7846
Mailing Address - Street 1:4377 COMMERCIAL WAY
Mailing Address - Street 2:127
Mailing Address - City:SPRING HILL
Mailing Address - State:FL
Mailing Address - Zip Code:34606-1963
Mailing Address - Country:US
Mailing Address - Phone:877-756-7846
Mailing Address - Fax:210-855-4236
Practice Address - Street 1:4377 COMMERCIAL WAY
Practice Address - Street 2:127
Practice Address - City:SPRING HILL
Practice Address - State:FL
Practice Address - Zip Code:34606-1963
Practice Address - Country:US
Practice Address - Phone:877-756-7846
Practice Address - Fax:210-855-4236
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-28
Last Update Date:2010-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment