Provider Demographics
NPI:1689679995
Name:ORTHOTIC PROSTHETIC SPECIALISTS, INC.
Entity Type:Organization
Organization Name:ORTHOTIC PROSTHETIC SPECIALISTS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:C
Authorized Official - Last Name:ROOKER
Authorized Official - Suffix:
Authorized Official - Credentials:CPO
Authorized Official - Phone:219-836-8668
Mailing Address - Street 1:625 RIDGE RD
Mailing Address - Street 2:STE D
Mailing Address - City:MUNSTER
Mailing Address - State:IN
Mailing Address - Zip Code:46321-1695
Mailing Address - Country:US
Mailing Address - Phone:219-836-8668
Mailing Address - Fax:219-836-8778
Practice Address - Street 1:625 RIDGE RD
Practice Address - Street 2:STE D
Practice Address - City:MUNSTER
Practice Address - State:IN
Practice Address - Zip Code:46321-1695
Practice Address - Country:US
Practice Address - Phone:219-836-8668
Practice Address - Fax:219-836-8778
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-15
Last Update Date:2013-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200511990AMedicaid
5353530001Medicare ID - Type Unspecified