Provider Demographics
NPI:1275539876
Name:MANUEL GARCIA PROSTHETICS LAB INC
Entity Type:Organization
Organization Name:MANUEL GARCIA PROSTHETICS LAB INC
Other - Org Name:MANUEL GARCIA PROSTHETIC & ORTHOTIC CENTERS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MANUEL
Authorized Official - Middle Name:R
Authorized Official - Last Name:GARCIA
Authorized Official - Suffix:
Authorized Official - Credentials:CPO, LPO
Authorized Official - Phone:440-243-1085
Mailing Address - Street 1:8180 PEARL RD
Mailing Address - Street 2:
Mailing Address - City:STRONGSVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:44136-1634
Mailing Address - Country:US
Mailing Address - Phone:440-243-1085
Mailing Address - Fax:440-243-2543
Practice Address - Street 1:8180 PEARL RD
Practice Address - Street 2:
Practice Address - City:STRONGSVILLE
Practice Address - State:OH
Practice Address - Zip Code:44136-1634
Practice Address - Country:US
Practice Address - Phone:440-243-1085
Practice Address - Fax:440-243-2543
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-28
Last Update Date:2022-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH528467335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0198914Medicaid
OH0279900001Medicare ID - Type Unspecified