Provider Demographics
NPI:1578550307
Name:BARTH ORTHOTIC AND PROSTHETIC SERVICES, P.C,
Entity Type:Organization
Organization Name:BARTH ORTHOTIC AND PROSTHETIC SERVICES, P.C,
Other - Org Name:HANGER CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF REIMBURSEMENT
Authorized Official - Prefix:MS
Authorized Official - First Name:SHERYL
Authorized Official - Middle Name:S
Authorized Official - Last Name:PRICE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:503-493-8288
Mailing Address - Street 1:355 W CARPENTER ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:SPRINGFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:62702-4922
Mailing Address - Country:US
Mailing Address - Phone:217-789-1450
Mailing Address - Fax:217-789-1454
Practice Address - Street 1:355 W CARPENTER ST
Practice Address - Street 2:SUITE B
Practice Address - City:SPRINGFIELD
Practice Address - State:IL
Practice Address - Zip Code:62702-4922
Practice Address - Country:US
Practice Address - Phone:217-789-1450
Practice Address - Fax:217-789-1454
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HANGER INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-10-06
Last Update Date:2013-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0008432043OtherBLUE CROSS BLUE SHIELD IL
IL322465121001Medicaid
IL361442736001Medicaid
IL174655OtherPERSONAL CARE
IL=========OtherCIGNA HEALTHCARE
IL0008432043OtherBLUE CROSS BLUE SHIELD IL
IL=========OtherHEALTH ALLIANCE
IL361442736001Medicaid
IL=========OtherHEALTH ALLIANCE
IL4620310001Medicare ID - Type Unspecified