Provider Demographics
NPI:1275628430
Name:CENTRAL PROSTHETICS & ORTHOTICS INC
Entity Type:Organization
Organization Name:CENTRAL PROSTHETICS & ORTHOTICS INC
Other - Org Name:CENTRAL BRACE & PROSTHETICS INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ED
Authorized Official - Middle Name:H
Authorized Official - Last Name:GILDEHAUS
Authorized Official - Suffix:III
Authorized Official - Credentials:CPO FAAOP CPED
Authorized Official - Phone:859-263-7712
Mailing Address - Street 1:3295 EAGLE VIEW LANE
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40509-1852
Mailing Address - Country:US
Mailing Address - Phone:859-263-7712
Mailing Address - Fax:859-263-7607
Practice Address - Street 1:3295 EAGLE VIEW LANE
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40509-1852
Practice Address - Country:US
Practice Address - Phone:859-263-7712
Practice Address - Fax:859-263-7607
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-04
Last Update Date:2010-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
000000066651OtherANTHEM
KY90030347Medicaid
9565OtherHUMANA
KY90030347Medicaid