Provider Demographics
NPI:1578522389
Name:ENDURACARE ORTHOTIC & PROSTHETIC SERVICES LLC
Entity Type:Organization
Organization Name:ENDURACARE ORTHOTIC & PROSTHETIC SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT / CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:PAUL
Authorized Official - Last Name:SERENARI
Authorized Official - Suffix:
Authorized Official - Credentials:CO BOCO
Authorized Official - Phone:724-930-8544
Mailing Address - Street 1:638 ROSTRAVER RD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:BELLE VERNON
Mailing Address - State:PA
Mailing Address - Zip Code:15012-1967
Mailing Address - Country:US
Mailing Address - Phone:724-930-8544
Mailing Address - Fax:724-930-8545
Practice Address - Street 1:638 ROSTRAVER RD
Practice Address - Street 2:SUITE 102
Practice Address - City:BELLE VERNON
Practice Address - State:PA
Practice Address - Zip Code:15012-1967
Practice Address - Country:US
Practice Address - Phone:724-930-8544
Practice Address - Fax:724-930-8545
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-21
Last Update Date:2012-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0019181990001OtherMEDICAL ASSISTANCE
PA3115996OtherAETNA
KY90011602Medicaid
PA134716Medicaid
PA1536991OtherGATEWAY
PA34358OtherINTERGROUP SERVICES
PA001415688OtherHIGHMARK BCBS
PA=========OtherDEVON
PA=========OtherCHOICE CARE
PA001415688OtherHIGHMARK BCBS
PA=========OtherCARELINK
PA=========OtherCIGNA
PA=========OtherHEALTH NET
KY90011602Medicaid
PA=========OtherALLIANCE
PA=========OtherAMERICAN HEALTHCARE
PA34358OtherINTERGROUP SERVICES
PA=========OtherHUMANA
PA0019181990001OtherMEDICAL ASSISTANCE
PA=========OtherALLIANCE