Provider Demographics
NPI:1447226287
Name:CENTRAL PA PROSTHETICS/ORTHOTICS, INC
Entity Type:Organization
Organization Name:CENTRAL PA PROSTHETICS/ORTHOTICS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:HOWARD
Authorized Official - Middle Name:C
Authorized Official - Last Name:STOUT
Authorized Official - Suffix:
Authorized Official - Credentials:CP
Authorized Official - Phone:570-672-4580
Mailing Address - Street 1:173 S MARKET ST
Mailing Address - Street 2:
Mailing Address - City:ELYSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17824-9757
Mailing Address - Country:US
Mailing Address - Phone:570-672-4580
Mailing Address - Fax:570-672-4581
Practice Address - Street 1:173 S MARKET ST
Practice Address - Street 2:
Practice Address - City:ELYSBURG
Practice Address - State:PA
Practice Address - Zip Code:17824-9757
Practice Address - Country:US
Practice Address - Phone:570-672-4580
Practice Address - Fax:570-672-4581
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CENTRAL PA PROSTHETICS/ORTHOTICS, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-02-23
Last Update Date:2017-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPO000182332B00000X
335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
2257250OtherAETNA
PA0014697350002Medicaid
PA220529OtherHIGHMARK BLUE SHIELD
PA139892OtherGHP
PA39HA89OtherBLUE CROSS
PA39HA89OtherBLUE CROSS