Provider Demographics
NPI:1104830462
Name:UNIVERSITY PEDORTHICS
Entity Type:Organization
Organization Name:UNIVERSITY PEDORTHICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JAMI
Authorized Official - Middle Name:
Authorized Official - Last Name:HEATH
Authorized Official - Suffix:
Authorized Official - Credentials:C-PED
Authorized Official - Phone:765-281-8900
Mailing Address - Street 1:413 S TILLOTSON AVE STE 4
Mailing Address - Street 2:
Mailing Address - City:MUNCIE
Mailing Address - State:IN
Mailing Address - Zip Code:47304-4368
Mailing Address - Country:US
Mailing Address - Phone:765-281-8900
Mailing Address - Fax:765-281-8999
Practice Address - Street 1:413 S TILLOTSON AVE STE 4
Practice Address - Street 2:
Practice Address - City:MUNCIE
Practice Address - State:IN
Practice Address - Zip Code:47304-4368
Practice Address - Country:US
Practice Address - Phone:765-281-8900
Practice Address - Fax:765-281-8999
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment