Provider Demographics
NPI:1417007154
Name:ORTHOTIC CONCEPTS INC
Entity Type:Organization
Organization Name:ORTHOTIC CONCEPTS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:WARREN
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:PATTEN
Authorized Official - Suffix:
Authorized Official - Credentials:CO, BOCO
Authorized Official - Phone:781-340-0444
Mailing Address - Street 1:320 LIBBEY INDUSTRIAL PKWY
Mailing Address - Street 2:SUITE 3A
Mailing Address - City:WEYMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02189-3107
Mailing Address - Country:US
Mailing Address - Phone:781-340-0444
Mailing Address - Fax:781-340-0486
Practice Address - Street 1:320 LIBBEY INDUSTRIAL PKWY
Practice Address - Street 2:SUITE 3A
Practice Address - City:WEYMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02189-3107
Practice Address - Country:US
Practice Address - Phone:781-340-0444
Practice Address - Fax:781-340-0486
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-12
Last Update Date:2010-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA611001OtherTUFTS HEALTH PLAN
MA1535536Medicaid
MA60251OtherFALLON
MA610474OtherHARVARD PILGRIM HEALTH
MA110029264AMedicaid
MA356154OtherBLUE CROSS BLUE SHIELD
MA0012446OtherNEIGHBORHOOD HEALTHPLAN
MA102857400OtherACS WORKER'S COMP
MA0012446OtherNEIGHBORHOOD HEALTHPLAN
MA611001OtherTUFTS HEALTH PLAN
MA110029264AMedicaid