Provider Demographics
NPI:1376525998
Name:ABC PROSTHETICS AND ORTHOTICS OF ALTAMONTE SPRINGS INC
Entity Type:Organization
Organization Name:ABC PROSTHETICS AND ORTHOTICS OF ALTAMONTE SPRINGS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:WENDY
Authorized Official - Middle Name:A
Authorized Official - Last Name:HARRIGAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-341-5873
Mailing Address - Street 1:691 DOUGLAS AVE
Mailing Address - Street 2:STE 103
Mailing Address - City:ALTAMONTE SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32714-2571
Mailing Address - Country:US
Mailing Address - Phone:407-772-1990
Mailing Address - Fax:407-772-1991
Practice Address - Street 1:691 DOUGLAS AVE
Practice Address - Street 2:STE 103
Practice Address - City:ALTAMONTE SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:32714-2571
Practice Address - Country:US
Practice Address - Phone:407-772-1990
Practice Address - Fax:407-772-1991
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPOR41335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLM2512OtherBLUE CROSS BLUE SHIELD
FL1273040001Medicare ID - Type Unspecified