Provider Demographics
NPI:1942279724
Name:AMPRO ORTHOTICS & PROSTHETICS, INC.
Entity type:Organization
Organization Name:AMPRO ORTHOTICS & PROSTHETICS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPERATIONS MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:PETRA
Authorized Official - Middle Name:
Authorized Official - Last Name:THIESSEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-457-3200
Mailing Address - Street 1:6877 S EASTERN AVE
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89119-0008
Mailing Address - Country:US
Mailing Address - Phone:702-457-3200
Mailing Address - Fax:702-457-0908
Practice Address - Street 1:6877 S EASTERN AVE
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89119-0008
Practice Address - Country:US
Practice Address - Phone:702-457-3200
Practice Address - Fax:702-457-0908
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-15
Last Update Date:2011-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV003302047Medicaid
NV003302047Medicaid