Provider Demographics
NPI:1598127490
Name:CENTER FOR ORTHOTIC & PROSTHETIC CARE OF SCRANTON, LLC
Entity Type:Organization
Organization Name:CENTER FOR ORTHOTIC & PROSTHETIC CARE OF SCRANTON, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REG COMPLIANCE SPECIALIST III
Authorized Official - Prefix:
Authorized Official - First Name:GRACE
Authorized Official - Middle Name:
Authorized Official - Last Name:ANGELINE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:714-961-2102
Mailing Address - Street 1:1500 MAIN ST
Mailing Address - Street 2:STE 2
Mailing Address - City:OLYPHANT
Mailing Address - State:PA
Mailing Address - Zip Code:18447-1343
Mailing Address - Country:US
Mailing Address - Phone:570-382-8208
Mailing Address - Fax:570-483-4880
Practice Address - Street 1:1500 MAIN ST
Practice Address - Street 2:STE 2
Practice Address - City:OLYPHANT
Practice Address - State:PA
Practice Address - Zip Code:18447-1343
Practice Address - Country:US
Practice Address - Phone:570-382-8208
Practice Address - Fax:570-483-4880
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-22
Last Update Date:2019-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier