Organization
ORTHOPRO OF LEWISTON INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MARSHALL R BLACK CPO (OWNER)
(208) 798-0200
Entity
Organization
Contact information
Practice address
823 16TH AVE, LEWISTON, ID 83501-3733
(208) 798-0200
(208) 798-0201
Mailing address
823 16TH AVE, LEWISTON, ID 83501-3733
(208) 798-0200
(208) 798-0201
Taxonomy
Speciality
Code
Description
License number
State
335E00000X
Prosthetic/Orthotic Supplier
Primary
—
—
Other
Enumeration date
11/21/2007
Last updated
09/27/2016
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