Provider Demographics
NPI:1194864850
Name:EAST COAST ORTHOTICS INC
Entity Type:Organization
Organization Name:EAST COAST ORTHOTICS INC
Other - Org Name:EAST COAST ORTHOTICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF REIMBURSEMENT
Authorized Official - Prefix:MS
Authorized Official - First Name:SHERYL
Authorized Official - Middle Name:
Authorized Official - Last Name:PRICE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:503-493-8288
Mailing Address - Street 1:129 W HIBISCUS BLVD STE N
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32901-3006
Mailing Address - Country:US
Mailing Address - Phone:321-724-5411
Mailing Address - Fax:321-724-6551
Practice Address - Street 1:129 W HIBISCUS BLVD STE N
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32901-3006
Practice Address - Country:US
Practice Address - Phone:321-724-5411
Practice Address - Fax:321-724-6551
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HANGER INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-02-06
Last Update Date:2013-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X
FLORT 2335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLM2332OtherBLUE CROSS BLUE SHIELD
FL5290148OtherAETNA PPO
FL0966993OtherAETNA
FL=========001OtherCIGNA
FL5290148OtherAETNA PPO
FL=========OtherTRICARE
FL=========001OtherCIGNA
FLM2332OtherBLUE CROSS BLUE SHIELD