Provider Demographics
NPI:1639061385
Name:BIONIC PROSTHETICS AND ORTHOTICS GROUP LLC
Entity type:Organization
Organization Name:BIONIC PROSTHETICS AND ORTHOTICS GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CONTRACTING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:
Authorized Official - Last Name:ALLEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-339-9671
Mailing Address - Street 1:8695 CONNECTICUT ST STE E
Mailing Address - Street 2:
Mailing Address - City:MERRILLVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46410-6240
Mailing Address - Country:US
Mailing Address - Phone:219-791-9200
Mailing Address - Fax:312-268-5389
Practice Address - Street 1:3935 EAGLE CREEK PKWY STE A
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46254-4690
Practice Address - Country:US
Practice Address - Phone:317-824-9990
Practice Address - Fax:317-342-5836
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-07-17
Last Update Date:2025-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier