Provider Demographics
NPI:1326344128
Name:ENDURACARE ORTHOTIC AND PROSTHETIC SERVICES, LLC
Entity Type:Organization
Organization Name:ENDURACARE ORTHOTIC AND PROSTHETIC SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT CEO
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:PAUL
Authorized Official - Last Name:SERENARI
Authorized Official - Suffix:
Authorized Official - Credentials:CO, BOCO
Authorized Official - Phone:724-350-0457
Mailing Address - Street 1:638 ROSTRAVER RD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:BELLE VERNON
Mailing Address - State:PA
Mailing Address - Zip Code:15012-1967
Mailing Address - Country:US
Mailing Address - Phone:724-930-8544
Mailing Address - Fax:724-930-8545
Practice Address - Street 1:110 DANIEL DR
Practice Address - Street 2:SUITE 6
Practice Address - City:UNIONTOWN
Practice Address - State:PA
Practice Address - Zip Code:15401-8002
Practice Address - Country:US
Practice Address - Phone:724-438-7900
Practice Address - Fax:724-438-7903
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-27
Last Update Date:2019-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA6000007742335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier