Provider Demographics
NPI:1164758785
Name:UNITED PROSTHETICS AND ORTHOTICS
Entity Type:Organization
Organization Name:UNITED PROSTHETICS AND ORTHOTICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:REGINALD
Authorized Official - Middle Name:A
Authorized Official - Last Name:MAYS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:904-444-3970
Mailing Address - Street 1:PO BOX 56886
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32241-6886
Mailing Address - Country:US
Mailing Address - Phone:904-638-9686
Mailing Address - Fax:
Practice Address - Street 1:9759 SAN JOSE BLVD STE 2
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32257-5418
Practice Address - Country:US
Practice Address - Phone:904-638-9686
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-02
Last Update Date:2010-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL511224P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
6308470001Medicare NSC