Provider Demographics
NPI:1376527986
Name:ORTHOTICS & PROSTHETICS REHABILITATION ENGINEERING CENTRE, INC.
Entity Type:Organization
Organization Name:ORTHOTICS & PROSTHETICS REHABILITATION ENGINEERING CENTRE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL/EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:N
Authorized Official - Last Name:BILLOCK
Authorized Official - Suffix:
Authorized Official - Credentials:CPO/L
Authorized Official - Phone:330-856-2553
Mailing Address - Street 1:700 HOWLAND WILSON RD SE
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:OH
Mailing Address - Zip Code:44484-2512
Mailing Address - Country:US
Mailing Address - Phone:330-856-2553
Mailing Address - Fax:330-856-4619
Practice Address - Street 1:700 HOWLAND WILSON RD SE
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:OH
Practice Address - Zip Code:44484-2512
Practice Address - Country:US
Practice Address - Phone:330-856-2553
Practice Address - Fax:330-856-4619
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000155607OtherANTHEM PROVIDER NUMBER
OH208430OtherHIGHMARK PROVIDER NUMBER
OH80283OtherNPN PROVIDER NUMBER
OH0595244Medicaid
OH208430OtherHIGHMARK PROVIDER NUMBER
OH=========005OtherMMOH PROVIDER NUMBER
OH0595244Medicaid