Provider Demographics
NPI:1508005463
Name:INDEPENDENCE PROSTHETICS-ORTHOTICS, INC.
Entity Type:Organization
Organization Name:INDEPENDENCE PROSTHETICS-ORTHOTICS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT / OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:HORNE
Authorized Official - Suffix:
Authorized Official - Credentials:CPO, CPED
Authorized Official - Phone:302-369-9476
Mailing Address - Street 1:31 MEADOWOOD DR
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:DE
Mailing Address - Zip Code:19711
Mailing Address - Country:US
Mailing Address - Phone:302-369-9476
Mailing Address - Fax:302-369-9060
Practice Address - Street 1:2711 EDGMONT AVE
Practice Address - Street 2:
Practice Address - City:BROOKHAVEN
Practice Address - State:PA
Practice Address - Zip Code:19015-3316
Practice Address - Country:US
Practice Address - Phone:610-876-4935
Practice Address - Fax:610-876-5940
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-16
Last Update Date:2011-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA5915790003Medicare NSC