Provider Demographics
NPI:1710270905
Name:TOTAL CARE ORTHOTICS AND PROSTHETICS, LLC
Entity Type:Organization
Organization Name:TOTAL CARE ORTHOTICS AND PROSTHETICS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:BREST
Authorized Official - Suffix:
Authorized Official - Credentials:CO, CPED
Authorized Official - Phone:918-502-5975
Mailing Address - Street 1:6565 S YALE AVE
Mailing Address - Street 2:STE 901
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74136-8327
Mailing Address - Country:US
Mailing Address - Phone:918-502-5975
Mailing Address - Fax:918-502-5980
Practice Address - Street 1:6565 S YALE AVE
Practice Address - Street 2:STE 901
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74136-8327
Practice Address - Country:US
Practice Address - Phone:918-502-5975
Practice Address - Fax:918-502-5980
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-19
Last Update Date:2011-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK6574280001Medicare NSC