EAST SIDE ORTHOTICS & PROSTHETICS (NPI# 1386602621) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1386602621 |
| Entity Type | Organization |
| Organization Name | EAST SIDE ORTHOTICS & PROSTHETICS |
| Practice Address |
17316 Ne Halsey St Portland OR 97230-6026 |
| Practice Telephone | 5032576623 |
| Practice Fax Number | 5032576624 |
| Mailing Telephone | 5032576623 |
| Mailing Fax Number | 5032576624 |
| Enumeration Date | 2006-05-03 |
| Last Update Date | 2019-06-11 |
| Authorized Official Name | BENJAMIN CLARK (PRESIDENT) |
| Authorized Official Telephone | 5032576623 |
| Authorized Official Credential | CPO |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 335E00000X | Prosthetic/Orthotic Supplier | Suppliers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| WA | WA DEPT OF SOCIAL AND HEALTH | 9027376 | 01 |
| OR | EVERCCARE | 82-00953 | 01 |
| OR | 297519 | 05 | |
| OR | OWCP | 611068100 | 01 |
| Street Address |
17316 NE HALSEY ST |
| City | PORTLAND |
| State | OR |
| Zip Code | 97230-6026 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1023497526 | Jeffery Warila | Orthotist | 17316 Ne Halsey St, Portland, OR 97230-6026 | 2015-05-29 |
| 1770871113 | Benjamin Clark | Orthotist | 17316 Ne Halsey St, Portland, OR 97230-6026 | 2011-07-19 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1932687233 | Timisha K Wilson | Social Worker | 12505 Ne Halsey St, Portland, OR 97230 | 2018-07-30 |
| 1356828768 | Sally Gail Logan | Pharmacist | 5725 Ne 138th Avenue, Portland, OR 97230 | 2018-07-27 |
| 1063937951 | Marley Elizabeth Small | Counselor | 1507 Ne 122nd Ave., Portland, OR 97230 | 2017-08-11 |
| 1447771316 | Shadab Nasreen Aijazi | Pathology | 5220 Ne 122nd Avenue, Portland, OR 97230 | 2017-06-30 |
| 1104378199 | Derek Andrus | Pharmacist | 5717 Nw 138th, Portland, OR 97230 | 2016-10-26 |
| 1164972675 | Rachael Anderson | Adult Companion | 423 Ne 160th Ave #11, Portland, OR 97230 | 2016-10-07 |
| 1750837597 | Providence Elderplace | Assisted Living Facility | 16430 Ne Hoyt St, Portland, OR 97230 | 2016-08-31 |
| 1649622473 | Sara Mcgroarty | Counselor | 17710 Ne Halsey Street, Portland, OR 97230 | 2016-07-05 |
| 1346699949 | Steven D Stanton | Counselor | 1022 Ne 181st Ave, C1, Portland, OR 97230 | 2016-06-06 |
| 1215390091 | The Wallace Medical Concern | Clinic/Center | 18139 Ne Couch Street, Portland, OR 97230 | 2016-03-30 |
| Find all providers in zip 97230 | ||||
| Taxonomy Code | 335E00000X |
| Grouping | Suppliers |
| Classification | Prosthetic/Orthotic Supplier |
| An organization that provides prosthetic and orthotic care which may include, but is not limited to, patient evaluation, prosthesis or orthosis design, fabrication, fitting and modification to treat limb loss for purposes of restoring physiological function and/or cosmesis or to treat a neuromusculoskeletal disorder or acquired condition. |
| Notes: Source: American Board for Certification in Orthotics, Prosthetics, and Pedorthics, Inc. [7/1/2010: modified, 7/1/2013: modified] Additional Resources: American Board for Certification in Orthotics, Prosthetics and Pedorthics, Inc., www.abcop.org and Board of Certification/Accreditation, International, www.bocusa.org. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1194023218 | Aryz Inc | Prosthetic/Orthotic Supplier | 671 Forest Ave, Portland, ME 04103-4158 | 2011-03-14 |
| 1023188778 | Orthotic Prosthetic Associates, Inc. | Prosthetic/Orthotic Supplier | 173 Ne 102nd Ave, Portland, OR 97220-4169 | 2006-11-09 |
| 1659306207 | Nordstrom Inc & Subsidiaries | Prosthetic/Orthotic Supplier | 1001 Lloyd Ctr, Portland, OR 97232-1238 | 2006-07-12 |
| 1669407219 | Nordstrom Inc & Subsidiaries | Prosthetic/Orthotic Supplier | 701 Sw Broadway, Portland, OR 97015-3301 | 2006-07-12 |
| 1902831563 | Nordstrom Inc & Subsidiaries | Prosthetic/Orthotic Supplier | 11900 Se 82nd Ave, Portland, OR 97086-7724 | 2006-07-12 |
| 1629003280 | Nordstrom Inc & Subsidiaries | Prosthetic/Orthotic Supplier | 9700 Sw Washington Square Rd, Portland, OR 97223-4453 | 2006-07-12 |
| 1265481758 | A Step Forward LLC | Prosthetic/Orthotic Supplier | 8605 Sw Terwilliger Blvd, Portland, OR 97219-4565 | 2006-05-10 |
| 1407811789 | Oregon Artificial Limb Co. | Prosthetic/Orthotic Supplier | 21 Ne Seventh Ave., Portland, OR 97232-2907 | 2006-04-19 |
| 1033112636 | Oregon Pedorthic Services | Prosthetic/Orthotic Supplier | 9932 Ne Halsey St, Portland, OR 97220-4474 | 2005-05-27 |
| 1174124390 | Austin Medical Products | Prosthetic/Orthotic Supplier | 21 Evergreen Dr, Portland, ME 04103-1067 | 2020-11-04 |
| Find all providers in PORTLAND | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.