Provider Demographics
NPI:1326169939
Name:CAPITAL PROSTHETIC AND ORTHOTIC CENTER, INC
Entity Type:Organization
Organization Name:CAPITAL PROSTHETIC AND ORTHOTIC CENTER, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:J
Authorized Official - Last Name:KOZERSKY
Authorized Official - Suffix:
Authorized Official - Credentials:LPO, CPO, FAAOP
Authorized Official - Phone:614-451-0446
Mailing Address - Street 1:20 EXECUTIVE CENTER DR
Mailing Address - Street 2:SUITE F
Mailing Address - City:CHILLICOTHE
Mailing Address - State:OH
Mailing Address - Zip Code:45601-8150
Mailing Address - Country:US
Mailing Address - Phone:740-779-3650
Mailing Address - Fax:740-779-3652
Practice Address - Street 1:20 EXECUTIVE CENTER DR
Practice Address - Street 2:SUITE F
Practice Address - City:CHILLICOTHE
Practice Address - State:OH
Practice Address - Zip Code:45601-8150
Practice Address - Country:US
Practice Address - Phone:740-779-3650
Practice Address - Fax:740-779-3652
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-02
Last Update Date:2011-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2930378Medicaid
OH0265110003Medicare NSC