Provider Demographics
NPI:1396819280
Name:BRACE SHOP & PROSTHETIC SERVICES INC
Entity Type:Organization
Organization Name:BRACE SHOP & PROSTHETIC SERVICES INC
Other - Org Name:THE BRACE SHOP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIR OF REIMBURSEMENT
Authorized Official - Prefix:
Authorized Official - First Name:SHERYL
Authorized Official - Middle Name:
Authorized Official - Last Name:PRICE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:503-493-8288
Mailing Address - Street 1:111 WELLINGTON PL
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45219-1758
Mailing Address - Country:US
Mailing Address - Phone:513-421-5653
Mailing Address - Fax:
Practice Address - Street 1:62 DOUGHTY RD
Practice Address - Street 2:
Practice Address - City:LAWRENCEBURG
Practice Address - State:IN
Practice Address - Zip Code:47025-2950
Practice Address - Country:US
Practice Address - Phone:513-421-5653
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HANGER ORTHOPEDIC GROUP
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-11-20
Last Update Date:2011-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY90254137Medicaid
OH0909502Medicaid
WV6305002000Medicaid
IN100001360AMedicaid
WV6305002000Medicaid
0244640002Medicare NSC