Provider Demographics
NPI:1003070459
Name:WESTERN RESERVE O & P CENTRE INC
Entity Type:Organization
Organization Name:WESTERN RESERVE O & P CENTRE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:L
Authorized Official - Last Name:GROPE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:330-792-6826
Mailing Address - Street 1:2235 E. PERSHING STREET
Mailing Address - Street 2:SUITE E
Mailing Address - City:SALEM
Mailing Address - State:OH
Mailing Address - Zip Code:44460
Mailing Address - Country:US
Mailing Address - Phone:330-337-8333
Mailing Address - Fax:330-337-8373
Practice Address - Street 1:1401 SOUTH ARCH AVENUE
Practice Address - Street 2:
Practice Address - City:ALLIANCE
Practice Address - State:OH
Practice Address - Zip Code:44601
Practice Address - Country:US
Practice Address - Phone:330-821-1000
Practice Address - Fax:330-821-1924
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WESTERN RESERVE O & P CENTRE INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-07-15
Last Update Date:2014-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHZZZ9ZZ5Medicaid
OH4228050001Medicare PIN