Provider Demographics
NPI:1649765421
Name:ORTHOTIC & PROSTHETIC CENTERS, INC.
Entity Type:Organization
Organization Name:ORTHOTIC & PROSTHETIC CENTERS, INC.
Other - Org Name:ORTHOTIC & PROSTHETIC CENTER OF STATESVILLE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF OPERATIONS & FINANCE
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTINA
Authorized Official - Middle Name:
Authorized Official - Last Name:GELAZNIK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:727-327-3332
Mailing Address - Street 1:3611 5TH AVE N
Mailing Address - Street 2:
Mailing Address - City:SAINT PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33713-7503
Mailing Address - Country:US
Mailing Address - Phone:727-327-3332
Mailing Address - Fax:
Practice Address - Street 1:1669 NORWOOD RD
Practice Address - Street 2:
Practice Address - City:STATESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28677-8201
Practice Address - Country:US
Practice Address - Phone:704-706-9330
Practice Address - Fax:704-706-9305
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-06-25
Last Update Date:2024-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1649765421Medicaid