Provider Demographics
NPI:1275536484
Name:ALLIANCE ORTHOPEDIC LABS, LLC
Entity Type:Organization
Organization Name:ALLIANCE ORTHOPEDIC LABS, LLC
Other - Org Name:TRANSCEND ORTHOTICS & PROSTHETICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:
Authorized Official - Last Name:LADERER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:574-233-3352
Mailing Address - Street 1:17530 DUGDALE DR
Mailing Address - Street 2:
Mailing Address - City:SOUTH BEND
Mailing Address - State:IN
Mailing Address - Zip Code:46635-1583
Mailing Address - Country:US
Mailing Address - Phone:574-233-3352
Mailing Address - Fax:574-288-1514
Practice Address - Street 1:134 HOLIDAY CT STE 302
Practice Address - Street 2:
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21401
Practice Address - Country:US
Practice Address - Phone:410-224-2000
Practice Address - Fax:410-224-5696
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TRANSCEND ORTHOTICS & PROSTHETICS, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-05-23
Last Update Date:2019-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD02991470335E00000X
335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC027147400Medicaid
MD714501200Medicaid
VA009190139Medicaid
1307310001Medicare PIN
MD1307310001Medicare ID - Type UnspecifiedPROVIDER ID NUMBER