Provider Demographics
NPI:1275521841
Name:AVRY'S ORTHOTIC FACILITY, INC.
Entity Type:Organization
Organization Name:AVRY'S ORTHOTIC FACILITY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:ALBANI
Authorized Official - Suffix:
Authorized Official - Credentials:CO
Authorized Official - Phone:330-746-5385
Mailing Address - Street 1:PO BOX 11206
Mailing Address - Street 2:
Mailing Address - City:YOUNGSTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44511-0206
Mailing Address - Country:US
Mailing Address - Phone:330-746-5385
Mailing Address - Fax:330-757-6089
Practice Address - Street 1:37 W MCKINLEY WAY
Practice Address - Street 2:
Practice Address - City:POLAND
Practice Address - State:OH
Practice Address - Zip Code:44514-1953
Practice Address - Country:US
Practice Address - Phone:330-757-6662
Practice Address - Fax:330-757-6089
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0170836Medicaid
OH000000155501OtherANTHEM
OH0170836Medicaid