Provider Demographics
NPI:1285819730
Name:GENE E WATTERS PROSTHETICS INC
Entity Type:Organization
Organization Name:GENE E WATTERS PROSTHETICS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:HARRY
Authorized Official - Middle Name:H
Authorized Official - Last Name:RUPP
Authorized Official - Suffix:
Authorized Official - Credentials:CP
Authorized Official - Phone:717-737-7831
Mailing Address - Street 1:PO BOX 66
Mailing Address - Street 2:
Mailing Address - City:LEMOYNE
Mailing Address - State:PA
Mailing Address - Zip Code:17043-0066
Mailing Address - Country:US
Mailing Address - Phone:717-737-7831
Mailing Address - Fax:717-763-0959
Practice Address - Street 1:722 STATE ST
Practice Address - Street 2:
Practice Address - City:LEMOYNE
Practice Address - State:PA
Practice Address - Zip Code:17043-1536
Practice Address - Country:US
Practice Address - Phone:717-737-7831
Practice Address - Fax:717-763-0959
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-03
Last Update Date:2008-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0138030001Medicare NSC