Provider Demographics
NPI:1306027628
Name:PREFERRED PROSTHETICS AND ORTHOTICS, INC.
Entity Type:Organization
Organization Name:PREFERRED PROSTHETICS AND ORTHOTICS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:LOUIS
Authorized Official - Last Name:DIBENEDETTO
Authorized Official - Suffix:
Authorized Official - Credentials:LPO
Authorized Official - Phone:330-259-0265
Mailing Address - Street 1:8571 FOXWOOD CT STE C
Mailing Address - Street 2:
Mailing Address - City:POLAND
Mailing Address - State:OH
Mailing Address - Zip Code:44514-4313
Mailing Address - Country:US
Mailing Address - Phone:330-259-0265
Mailing Address - Fax:330-259-0272
Practice Address - Street 1:8571 FOXWOOD CT STE C
Practice Address - Street 2:
Practice Address - City:POLAND
Practice Address - State:OH
Practice Address - Zip Code:44514-4313
Practice Address - Country:US
Practice Address - Phone:330-259-0265
Practice Address - Fax:330-259-0272
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-15
Last Update Date:2007-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHLPO23335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000244821OtherANTHEM BC/BS
OH2347366Medicaid
OH4546910001Medicare NSC