Provider Demographics
NPI:1184119976
Name:ORTHOTIC & PROSTHETIC CENTERS, INC.
Entity type:Organization
Organization Name:ORTHOTIC & PROSTHETIC CENTERS, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF FINANCE & OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTINA
Authorized Official - Middle Name:
Authorized Official - Last Name:GELAZNIK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:727-498-1003
Mailing Address - Street 1:3611 5TH AVE N
Mailing Address - Street 2:
Mailing Address - City:SAINT PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33713-7503
Mailing Address - Country:US
Mailing Address - Phone:727-327-3332
Mailing Address - Fax:
Practice Address - Street 1:9241 UNIVERSITY BLVD STE B1
Practice Address - Street 2:
Practice Address - City:NORTH CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29406-9349
Practice Address - Country:US
Practice Address - Phone:843-531-9990
Practice Address - Fax:843-804-4811
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-06-25
Last Update Date:2022-11-15
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
SCDE3897Medicaid