Provider Demographics
NPI:1629306352
Name:PRECISION ORTHOTIC & PROSTHETIC TECHNOLOGY INC
Entity Type:Organization
Organization Name:PRECISION ORTHOTIC & PROSTHETIC TECHNOLOGY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:E
Authorized Official - Last Name:HEBERT
Authorized Official - Suffix:
Authorized Official - Credentials:CPO CFO
Authorized Official - Phone:508-991-5577
Mailing Address - Street 1:300 HANOVER ST
Mailing Address - Street 2:SUITE 1G
Mailing Address - City:FALL RIVER
Mailing Address - State:MA
Mailing Address - Zip Code:02720-5444
Mailing Address - Country:US
Mailing Address - Phone:508-991-5577
Mailing Address - Fax:508-991-5505
Practice Address - Street 1:300 HANOVER ST
Practice Address - Street 2:SUITE 1G
Practice Address - City:FALL RIVER
Practice Address - State:MA
Practice Address - Zip Code:02720-5444
Practice Address - Country:US
Practice Address - Phone:508-991-5577
Practice Address - Fax:508-991-5505
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-18
Last Update Date:2009-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAAA33007OtherHARVARD PILGRIM
MAOWCPOther610047000
MA400554OtherBLUE CROSS BLUE SHIELD
MA00000029723OtherBMC HEALTHNET
MA1528271Medicaid
MA642391OtherTUFTS
MA1528271Medicaid