Provider Demographics
NPI:1568436269
Name:CAPE PROSTHETICS-ORTHOTICS, INC.
Entity Type:Organization
Organization Name:CAPE PROSTHETICS-ORTHOTICS, INC.
Other - Org Name:STANDARD ARTIFICIAL LIMB
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:DENNIS
Authorized Official - Middle Name:
Authorized Official - Last Name:FITZPATRICK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:610-644-7824
Mailing Address - Street 1:1904 OLIVE ST
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63103-1626
Mailing Address - Country:US
Mailing Address - Phone:314-231-1156
Mailing Address - Fax:314-436-1493
Practice Address - Street 1:4010 N ILLINOIS ST
Practice Address - Street 2:ROUTE 159
Practice Address - City:SWANSEA
Practice Address - State:IL
Practice Address - Zip Code:62226-1946
Practice Address - Country:US
Practice Address - Phone:618-235-5191
Practice Address - Fax:618-235-8304
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-17
Last Update Date:2008-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDST. CLAIR COUNTY335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL62226-01Medicaid
IL0186280007Medicare NSC