Provider Demographics
NPI:1154323558
Name:LEIMKUEHLER ORTHOTIC-PROSTHETIC CENTER, INC.
Entity Type:Organization
Organization Name:LEIMKUEHLER ORTHOTIC-PROSTHETIC CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:LEIMKUEHLER
Authorized Official - Suffix:SR
Authorized Official - Credentials:CPO
Authorized Official - Phone:440-988-5770
Mailing Address - Street 1:205 N LEAVITT RD
Mailing Address - Street 2:
Mailing Address - City:AMHERST
Mailing Address - State:OH
Mailing Address - Zip Code:44001-1124
Mailing Address - Country:US
Mailing Address - Phone:440-988-5770
Mailing Address - Fax:440-988-5776
Practice Address - Street 1:205 N LEAVITT RD
Practice Address - Street 2:
Practice Address - City:AMHERST
Practice Address - State:OH
Practice Address - Zip Code:44001-1124
Practice Address - Country:US
Practice Address - Phone:440-988-5770
Practice Address - Fax:440-988-5776
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-15
Last Update Date:2021-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHLP0072222Z00000X
OHLP0065224P00000X
335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
No222Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotistGroup - Multi-Specialty
No224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0830293Medicaid
OH0830293Medicaid