Provider Demographics
NPI:1275533424
Name:MORGANTOWN ORTHOTIC & PROSTHETIC CENTER, INC
Entity Type:Organization
Organization Name:MORGANTOWN ORTHOTIC & PROSTHETIC CENTER, INC
Other - Org Name:MOPC INC MORGANTOWN O&P CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CO DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:GORMAN
Authorized Official - Suffix:
Authorized Official - Credentials:CPO
Authorized Official - Phone:304-598-0528
Mailing Address - Street 1:7000 HAMPTON CTR
Mailing Address - Street 2:SUITE A
Mailing Address - City:MORGANTOWN
Mailing Address - State:WV
Mailing Address - Zip Code:26505-1720
Mailing Address - Country:US
Mailing Address - Phone:304-598-0528
Mailing Address - Fax:304-598-0527
Practice Address - Street 1:7000 HAMPTON CTR
Practice Address - Street 2:SUITE A
Practice Address - City:MORGANTOWN
Practice Address - State:WV
Practice Address - Zip Code:26505-1720
Practice Address - Country:US
Practice Address - Phone:304-598-0528
Practice Address - Fax:304-598-0527
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-29
Last Update Date:2019-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0147264000Medicaid
WV0224660001Medicare NSC