Provider Demographics
NPI:1366504425
Name:PROSTHETIC CENTER OF PASCO INC
Entity Type:Organization
Organization Name:PROSTHETIC CENTER OF PASCO INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:D
Authorized Official - Last Name:MCCULLOUGH
Authorized Official - Suffix:
Authorized Official - Credentials:CP
Authorized Official - Phone:727-846-8124
Mailing Address - Street 1:5950 HIGH STREET
Mailing Address - Street 2:
Mailing Address - City:NEW PORT RICHEY
Mailing Address - State:FL
Mailing Address - Zip Code:34652-4149
Mailing Address - Country:US
Mailing Address - Phone:727-846-8124
Mailing Address - Fax:727-846-7109
Practice Address - Street 1:5950 HIGH STREET
Practice Address - Street 2:
Practice Address - City:NEW PORT RICHEY
Practice Address - State:FL
Practice Address - Zip Code:34652-4149
Practice Address - Country:US
Practice Address - Phone:727-846-8124
Practice Address - Fax:727-846-7109
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPRO6335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL0363610001Medicare ID - Type Unspecified