Organization
CLEARWATER ORTHOTICS AND PROSTHETICS, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KAREN HALE (OFFICE MANAGER)
(818) 357-5732
Entity
Organization
Contact information
Practice address
801 BRYDEN AVE, LEWISTON, ID 83501-4927
(208) 798-4605
Mailing address
PO BOX 2620, HAYDEN, ID 83835-2620
Taxonomy
Speciality
Code
Description
License number
State
335E00000X
Prosthetic/Orthotic Supplier
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000010028073
REGENCE BLUE SHIELD OF ID
ID
01
—
135273
L&I
WA
05
—
805399000
—
ID
01
—
8M820
BLUE CROSS OF IDAHO
ID
05
—
9047259
—
WA
Enumeration date
04/24/2007
Last updated
12/01/2011
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