Provider Demographics
NPI:1295814143
Name:CENTRAL ORTHOTIC & PROSTHETIC CO INC
Entity Type:Organization
Organization Name:CENTRAL ORTHOTIC & PROSTHETIC CO INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:C
Authorized Official - Last Name:BEEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:814-535-8221
Mailing Address - Street 1:725 FRANKLIN ST
Mailing Address - Street 2:
Mailing Address - City:JOHNSTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:15901-2823
Mailing Address - Country:US
Mailing Address - Phone:814-535-8221
Mailing Address - Fax:814-536-9047
Practice Address - Street 1:3271 ROUTE 119 HWY S
Practice Address - Street 2:
Practice Address - City:HOMER CITY
Practice Address - State:PA
Practice Address - Zip Code:15748-6901
Practice Address - Country:US
Practice Address - Phone:724-479-2440
Practice Address - Fax:814-536-9047
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-03
Last Update Date:2015-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1007283160001Medicaid
PA1007283160001Medicaid