Provider Demographics
NPI:1508106675
Name:MAXCARE ORTHOTICS AND PROSTHETICS LLC
Entity Type:Organization
Organization Name:MAXCARE ORTHOTICS AND PROSTHETICS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:A
Authorized Official - Last Name:HAINES
Authorized Official - Suffix:
Authorized Official - Credentials:CO
Authorized Official - Phone:574-267-5852
Mailing Address - Street 1:3159 E CENTER STREET EXT
Mailing Address - Street 2:
Mailing Address - City:WARSAW
Mailing Address - State:IN
Mailing Address - Zip Code:46582-3901
Mailing Address - Country:US
Mailing Address - Phone:574-267-5852
Mailing Address - Fax:574-267-6239
Practice Address - Street 1:3159 E CENTER STREET EXT
Practice Address - Street 2:
Practice Address - City:WARSAW
Practice Address - State:IN
Practice Address - Zip Code:46582-3901
Practice Address - Country:US
Practice Address - Phone:574-267-5852
Practice Address - Fax:574-267-6239
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-26
Last Update Date:2013-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier