Provider Demographics
NPI:1679564546
Name:ORTHOTICS & PROSTHETICS LABORATORIES, INC
Entity Type:Organization
Organization Name:ORTHOTICS & PROSTHETICS LABORATORIES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:T
Authorized Official - Last Name:HAAS
Authorized Official - Suffix:
Authorized Official - Credentials:CO
Authorized Official - Phone:413-737-2404
Mailing Address - Street 1:3500 MAIN ST STE 101
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01107-1150
Mailing Address - Country:US
Mailing Address - Phone:413-737-2404
Mailing Address - Fax:413-733-1389
Practice Address - Street 1:3500 MAIN ST STE 101
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01107-1150
Practice Address - Country:US
Practice Address - Phone:413-737-2404
Practice Address - Fax:413-733-1389
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-31
Last Update Date:2021-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes222Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotistGroup - Multi-Specialty
No224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetistGroup - Multi-Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
15121OtherHEALTH NEW ENGLAND
CT3048436Medicaid
475460OtherCIGNA
553174OtherAETNA
0008938OtherNEIGHBORHOOD HEALTH PLAN
VT1009994Medicaid
102318400OtherUS DEPT OF LABOR
MA1540408Medicaid
701312OtherHARVARD PILGRIM HEALTHCAR
803119OtherTUFTS HEALTH PLAN
S009509OtherTRICARE
000000006888OtherBMC HEALTHNET PLAN
43871OtherFALLAN HEALTHCARE
65955037OtherVETERANS ADMINISTRATORS
833821OtherMVP HEALTH PLAN
MA360154OtherBCBS
734427OtherCONNECTICARE