Provider Demographics
NPI:1174529937
Name:ORTHOTIC PROSTHETIC CENTER, INC
Entity type:Organization
Organization Name:ORTHOTIC PROSTHETIC CENTER, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANN
Authorized Official - Middle Name:M
Authorized Official - Last Name:COLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:419-531-2222
Mailing Address - Street 1:419 N REYNOLDS RD
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43615
Mailing Address - Country:US
Mailing Address - Phone:419-531-2222
Mailing Address - Fax:419-531-2359
Practice Address - Street 1:419 N REYNOLDS RD
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43615
Practice Address - Country:US
Practice Address - Phone:419-531-2222
Practice Address - Fax:419-531-2359
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-24
Last Update Date:2022-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHLO.56335E00000X
OHCO003462335E00000X
OHCP002589335E00000X
OHLP.55335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH10209OtherPARAMOUNT
OH000000155767OtherANTHEM BCBS
OH0848300Medicaid
OH0848300Medicaid
OH10209OtherPARAMOUNT
OH=========00OtherBUREAU OF WORKMES COMP