Provider Demographics
NPI:1508868878
Name:PRECISION ORTHOTIC & PROSTHETIC TECHNOLOGY, INC.
Entity Type:Organization
Organization Name:PRECISION ORTHOTIC & PROSTHETIC TECHNOLOGY, INC.
Other - Org Name:PRECISION O&P TECHNOLOGY, INC.
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:E
Authorized Official - Last Name:HEBERT
Authorized Official - Suffix:
Authorized Official - Credentials:CP
Authorized Official - Phone:508-991-5577
Mailing Address - Street 1:203 POPES ISLAND
Mailing Address - Street 2:
Mailing Address - City:NEW BEDFORD
Mailing Address - State:MA
Mailing Address - Zip Code:02740-7232
Mailing Address - Country:US
Mailing Address - Phone:508-991-5577
Mailing Address - Fax:508-991-5505
Practice Address - Street 1:203 POPES ISLAND
Practice Address - Street 2:
Practice Address - City:NEW BEDFORD
Practice Address - State:MA
Practice Address - Zip Code:02740-7232
Practice Address - Country:US
Practice Address - Phone:508-991-5577
Practice Address - Fax:508-991-5505
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-01
Last Update Date:2008-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1528271Medicaid
MAAA33007OtherHARVARD PILGRIM
MA400554OtherBCBS
MA29723OtherBMC HEALTHNET
MA642391OtherTUFTS
MA610047000OtherACS OR OWCP
MAVC0000202516OtherMASS REHAB
MA=========OtherTRICARE
MAVC0000202516OtherMASS REHAB