Provider Demographics
NPI:1972621365
Name:ORTHO MEDICS
Entity type:Organization
Organization Name:ORTHO MEDICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:C.O.
Authorized Official - Prefix:MR
Authorized Official - First Name:JACOB
Authorized Official - Middle Name:W
Authorized Official - Last Name:SIKES
Authorized Official - Suffix:
Authorized Official - Credentials:CO
Authorized Official - Phone:308-237-6105
Mailing Address - Street 1:8 W 56TH ST
Mailing Address - Street 2:
Mailing Address - City:KEARNEY
Mailing Address - State:NE
Mailing Address - Zip Code:68847-0503
Mailing Address - Country:US
Mailing Address - Phone:308-237-6105
Mailing Address - Fax:308-237-6106
Practice Address - Street 1:8 W 56TH ST
Practice Address - Street 2:
Practice Address - City:KEARNEY
Practice Address - State:NE
Practice Address - Zip Code:68847-0503
Practice Address - Country:US
Practice Address - Phone:308-237-6105
Practice Address - Fax:308-237-6106
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-26
Last Update Date:2007-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10025525800Medicaid
5897780001Medicare NSC