1154479798 NPI number — ORTHOTIC & PROSTHETIC LAB INC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1154479798 NPI number — ORTHOTIC & PROSTHETIC LAB INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ORTHOTIC & PROSTHETIC LAB INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1154479798
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/04/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
125 N WEINBACH AVE
Provider Second Line Business Mailing Address:
SUITE 310
Provider Business Mailing Address City Name:
EVANSVILLE
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
47711-6091
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
812-479-6298
Provider Business Mailing Address Fax Number:
812-479-6758

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
125 N WEINBACH AVE
Provider Second Line Business Practice Location Address:
SUITE 310
Provider Business Practice Location Address City Name:
EVANSVILLE
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
47711-6091
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
812-479-6298
Provider Business Practice Location Address Fax Number:
812-479-6758
Provider Enumeration Date:
01/08/2007

Additional Information

Authorized Official

Authorized Official Last Name:
ALLEN
Authorized Official First Name:
CYNTHIA
Authorized Official Middle Name:
KAYE
Authorized Official Title or Position:
OFFICE MANAGER
Authorized Official Telephone Number:
812-479-6298

Provider Taxonomy Codes

  • Taxonomy code: 332BC3200X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 100179970A , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com