Provider Demographics
NPI:1679840607
Name:SENIORCARE ORTHOTICS INC
Entity Type:Organization
Organization Name:SENIORCARE ORTHOTICS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DON
Authorized Official - Middle Name:
Authorized Official - Last Name:HAVEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-497-7782
Mailing Address - Street 1:12166 OLD BIG BEND ROAD
Mailing Address - Street 2:SUITE 303
Mailing Address - City:KIRKWOOD
Mailing Address - State:MO
Mailing Address - Zip Code:63122-6836
Mailing Address - Country:US
Mailing Address - Phone:314-821-2600
Mailing Address - Fax:
Practice Address - Street 1:12166 OLD BIG BEND ROAD
Practice Address - Street 2:SUITE 303
Practice Address - City:KIRKWOOD
Practice Address - State:MO
Practice Address - Zip Code:63122-6836
Practice Address - Country:US
Practice Address - Phone:314-821-2600
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-18
Last Update Date:2012-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
6627610001Medicare NSC