Provider Demographics
NPI:1437339710
Name:ORTHOTIC & PROSTHETIC SPECIALISTS, INC.
Entity Type:Organization
Organization Name:ORTHOTIC & PROSTHETIC SPECIALISTS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:STEPHEN
Authorized Official - Last Name:RELLE
Authorized Official - Suffix:
Authorized Official - Credentials:CPO
Authorized Official - Phone:985-898-6319
Mailing Address - Street 1:101 HIGHLAND PARK PLZ
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:LA
Mailing Address - Zip Code:70433-7128
Mailing Address - Country:US
Mailing Address - Phone:985-898-6319
Mailing Address - Fax:
Practice Address - Street 1:101 HIGHLAND PARK PLZ
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:LA
Practice Address - Zip Code:70433-7128
Practice Address - Country:US
Practice Address - Phone:985-898-6319
Practice Address - Fax:985-867-8803
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-05
Last Update Date:2020-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00440535Medicaid
LA1980391Medicaid
LA0663160001Medicare NSC
MS0663160003Medicare NSC
MS00440535Medicaid