Provider Demographics
NPI:1689707481
Name:PROSTHETIC CONSULTANTS INC
Entity Type:Organization
Organization Name:PROSTHETIC CONSULTANTS INC
Other - Org Name:SHAMP BIONICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:MARK
Authorized Official - Last Name:SHAMP
Authorized Official - Suffix:
Authorized Official - Credentials:CP
Authorized Official - Phone:330-644-4201
Mailing Address - Street 1:2656 S ARLINGTON RD
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44319-2060
Mailing Address - Country:US
Mailing Address - Phone:330-644-4201
Mailing Address - Fax:330-644-4202
Practice Address - Street 1:2656 S ARLINGTON RD
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44319-2060
Practice Address - Country:US
Practice Address - Phone:330-644-4201
Practice Address - Fax:330-644-4202
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-13
Last Update Date:2012-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHLP211335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0877485Medicaid
OH0223140001Medicare ID - Type Unspecified