1760742274 NPI number — ORTHOTIC AND PROSTHETIC DESIGNS, LLC

Table of content: (NPI 1760742274)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1760742274 NPI number — ORTHOTIC AND PROSTHETIC DESIGNS, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ORTHOTIC AND PROSTHETIC DESIGNS, LLC
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:
1760742274
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/04/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3200 SYCAMORE CT STE 2B
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
COLUMBUS
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
47203-1552
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
812-372-9002
Provider Business Mailing Address Fax Number:
812-372-9088

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5120 COMMERCE CIR STE 104
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
INDIANAPOLIS
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
46237-9717
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
317-882-9002
Provider Business Practice Location Address Fax Number:
317-882-9003
Provider Enumeration Date:
05/18/2012

Additional Information

Authorized Official

Authorized Official Last Name:
KEAN
Authorized Official First Name:
JULIE
Authorized Official Middle Name:
Authorized Official Title or Position:
PARTNER
Authorized Official Telephone Number:
812-372-9002

Provider Taxonomy Codes

  • Taxonomy code: 335E00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 000000306652 . This is a "ANTHEM" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: 035386P . This is a "SIHO" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: 200469430A , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 201528 . This is a "CHILDREN'S SPECIAL HEALTH CARE SERVICES" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: 200735370A . This is a "FIRST STEPS" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".




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