Provider Demographics
NPI:1588085278
Name:ALPHA-OMEGA ORTHOTICS & PROSTHETICS, INC.
Entity type:Organization
Organization Name:ALPHA-OMEGA ORTHOTICS & PROSTHETICS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:
Authorized Official - Last Name:VAHL
Authorized Official - Suffix:
Authorized Official - Credentials:CPO
Authorized Official - Phone:417-886-8881
Mailing Address - Street 1:2021 S WAVERLY AVE
Mailing Address - Street 2:SUITE 300
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65804-2414
Mailing Address - Country:US
Mailing Address - Phone:417-886-8881
Mailing Address - Fax:417-881-8223
Practice Address - Street 1:785 E DRAKE ST
Practice Address - Street 2:
Practice Address - City:BOLIVAR
Practice Address - State:MO
Practice Address - Zip Code:65613-2739
Practice Address - Country:US
Practice Address - Phone:417-886-8881
Practice Address - Fax:417-881-8223
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ALPHA-OMEGA ORTHOTICS & PROSTHETICS, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-12-23
Last Update Date:2014-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOBUS-0027960335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO0996130002Medicare NSC
MO0996130003Medicare NSC
MO0996130001Medicare NSC