Provider Demographics
NPI:1033185764
Name:NORTH COAST ORTHOTICS AND PROSTHETICS INC
Entity Type:Organization
Organization Name:NORTH COAST ORTHOTICS AND PROSTHETICS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:J
Authorized Official - Last Name:YAKOVICH
Authorized Official - Suffix:
Authorized Official - Credentials:CO
Authorized Official - Phone:440-233-4314
Mailing Address - Street 1:6100 S BROADWAY
Mailing Address - Street 2:ST# 104
Mailing Address - City:LORAIN
Mailing Address - State:OH
Mailing Address - Zip Code:44053-3874
Mailing Address - Country:US
Mailing Address - Phone:440-233-4314
Mailing Address - Fax:
Practice Address - Street 1:15900 SNOW RD
Practice Address - Street 2:ST# 400
Practice Address - City:BROOKPARK
Practice Address - State:OH
Practice Address - Zip Code:44142-2859
Practice Address - Country:US
Practice Address - Phone:877-236-5501
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-23
Last Update Date:2011-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2815387Medicaid
OH0191650002Medicare NSC