Provider Demographics
NPI:1154328078
Name:ORTHO-TEC MEDICAL, INC.
Entity Type:Organization
Organization Name:ORTHO-TEC MEDICAL, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:HAYNES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:888-616-9811
Mailing Address - Street 1:P.O. BOX 364
Mailing Address - Street 2:
Mailing Address - City:WEBSTER
Mailing Address - State:MA
Mailing Address - Zip Code:01570-0364
Mailing Address - Country:US
Mailing Address - Phone:888-616-9811
Mailing Address - Fax:888-616-9812
Practice Address - Street 1:15 GORE ROAD
Practice Address - Street 2:
Practice Address - City:WEBSTER
Practice Address - State:MA
Practice Address - Zip Code:01570-6834
Practice Address - Country:US
Practice Address - Phone:888-616-9811
Practice Address - Fax:888-616-9812
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-07
Last Update Date:2015-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME1154328078Medicaid
MA1537172Medicaid
RI5830001Medicaid
MA604729OtherTUFTS HEALTH PLAN
1154328078OtherTRICARE
CT003107936Medicaid
370854OtherBCBS OF MASSACHUSETTS
MA1154328078OtherHPHC INSURANCE COMPANY
42008OtherFALLON COMMUNITY HEALTH P
8200076OtherEVERCARE
1154328078OtherTRICARE
MA1537172Medicaid