1679564546 NPI number — ORTHOTICS & PROSTHETICS LABORATORIES, INC

Table of content: (NPI 1679564546)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1679564546 NPI number — ORTHOTICS & PROSTHETICS LABORATORIES, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ORTHOTICS & PROSTHETICS LABORATORIES, 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:
1679564546
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/18/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3500 MAIN ST STE 101
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SPRINGFIELD
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
01107-1150
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
413-737-2404
Provider Business Mailing Address Fax Number:
413-733-1389

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3500 MAIN ST STE 101
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SPRINGFIELD
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
01107-1150
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
413-737-2404
Provider Business Practice Location Address Fax Number:
413-733-1389
Provider Enumeration Date:
10/31/2005

Additional Information

Authorized Official

Authorized Official Last Name:
HAAS
Authorized Official First Name:
JAMES
Authorized Official Middle Name:
T
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
413-737-2404

Provider Taxonomy Codes

  • Taxonomy code: 222Z00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 224P00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 332B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 335E00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 102318400 . This is a "US DEPT OF LABOR" identifier . This identifiers is of the category "OTHER".
  • Identifier: 15121 . This is a "HEALTH NEW ENGLAND" identifier . This identifiers is of the category "OTHER".
  • Identifier: 360154 . This is a "BCBS" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 475460 . This is a "CIGNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 000000006888 . This is a "BMC HEALTHNET PLAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1009994 , issued by the state of ( VT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 43871 . This is a "FALLAN HEALTHCARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 734427 . This is a "CONNECTICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1540408 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 3048436 , issued by the state of ( CT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0008938 . This is a "NEIGHBORHOOD HEALTH PLAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 701312 . This is a "HARVARD PILGRIM HEALTHCAR" identifier . This identifiers is of the category "OTHER".
  • Identifier: 803119 . This is a "TUFTS HEALTH PLAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 553174 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 65955037 . This is a "VETERANS ADMINISTRATORS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 833821 . This is a "MVP HEALTH PLAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: S009509 . This is a "TRICARE" identifier . This identifiers is of the category "OTHER".




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