Provider Demographics
NPI:1083623037
Name:ORTHOTIC & PROSTHETIC SERVICES INC
Entity Type:Organization
Organization Name:ORTHOTIC & PROSTHETIC SERVICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:JUSTIN
Authorized Official - Middle Name:
Authorized Official - Last Name:PROCTOR
Authorized Official - Suffix:
Authorized Official - Credentials:CPO/LPO
Authorized Official - Phone:330-723-6679
Mailing Address - Street 1:799 N. COURT ST.
Mailing Address - Street 2:SUITE 1
Mailing Address - City:MEDINA
Mailing Address - State:OH
Mailing Address - Zip Code:44256-3137
Mailing Address - Country:US
Mailing Address - Phone:330-723-6679
Mailing Address - Fax:330-722-7727
Practice Address - Street 1:2261 WARRENSVILLE CENTER RD
Practice Address - Street 2:SUITE A
Practice Address - City:UNIVERSITY HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44118-3143
Practice Address - Country:US
Practice Address - Phone:330-723-6679
Practice Address - Fax:330-722-7727
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-07
Last Update Date:2013-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHLPO202332B00000X, 335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH3016168Medicaid
OH3016168Medicaid