Provider Demographics
NPI:1245233642
Name:WILLIAMSPORT ORTHOPEDIC & PROSTHETIC COMPANY INC
Entity Type:Organization
Organization Name:WILLIAMSPORT ORTHOPEDIC & PROSTHETIC COMPANY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KATHLEEN
Authorized Official - Middle Name:
Authorized Official - Last Name:BORGESS
Authorized Official - Suffix:
Authorized Official - Credentials:BOC-O
Authorized Official - Phone:570-322-5277
Mailing Address - Street 1:251 PENN ST STE 1
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSPORT
Mailing Address - State:PA
Mailing Address - Zip Code:17701-5310
Mailing Address - Country:US
Mailing Address - Phone:570-322-5277
Mailing Address - Fax:570-322-1289
Practice Address - Street 1:251 PENN ST STE 1
Practice Address - Street 2:
Practice Address - City:WILLIAMSPORT
Practice Address - State:PA
Practice Address - Zip Code:17701-5310
Practice Address - Country:US
Practice Address - Phone:570-322-5277
Practice Address - Fax:570-322-1289
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-05-31
Last Update Date:2023-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA000282784OtherHIGHMARK BLUE CROSS
PA0005734430001Medicaid
PA37618OtherHEALTH AMERICA
PA814220OtherFIRST PRIORITY HEALTH
PA814220OtherFIRST PRIORITY HEALTH