Provider Demographics
NPI:1548796121
Name:IRENE M BOYD DBA/TRI-COUNTY ORTHOTIC PROSTHETIC INSTITUTE
Entity Type:Organization
Organization Name:IRENE M BOYD DBA/TRI-COUNTY ORTHOTIC PROSTHETIC INSTITUTE
Other - Org Name:TRI-COUNTY ORTHOTIC PROSTHETIC INSTITUTE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTER & MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:IRENE
Authorized Official - Middle Name:WILCOX
Authorized Official - Last Name:BOYD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:352-493-0360
Mailing Address - Street 1:1411 NW 23RD AVE
Mailing Address - Street 2:
Mailing Address - City:CHIEFLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32626-1976
Mailing Address - Country:US
Mailing Address - Phone:352-493-0360
Mailing Address - Fax:352-493-0369
Practice Address - Street 1:1329 SE 25TH LOOP
Practice Address - Street 2:UNIT # 102
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34471-6090
Practice Address - Country:US
Practice Address - Phone:352-671-1225
Practice Address - Fax:352-620-2650
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-03
Last Update Date:2019-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X
FLPOR 92174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Yes332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL001907500Medicaid