Provider Demographics
NPI:1407921745
Name:PRICE MEDICAL PROSTHETICS & ORTHOTICS,INC.
Entity Type:Organization
Organization Name:PRICE MEDICAL PROSTHETICS & ORTHOTICS,INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:SEAN
Authorized Official - Last Name:PRICE
Authorized Official - Suffix:
Authorized Official - Credentials:CPO
Authorized Official - Phone:229-878-2205
Mailing Address - Street 1:1115 13TH AVE
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:GA
Mailing Address - Zip Code:31707-3522
Mailing Address - Country:US
Mailing Address - Phone:229-878-2205
Mailing Address - Fax:229-878-2204
Practice Address - Street 1:1115 13TH AVE
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:GA
Practice Address - Zip Code:31707-3522
Practice Address - Country:US
Practice Address - Phone:229-878-2205
Practice Address - Fax:229-878-2204
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA4953080001Medicare NSC