Provider Demographics
NPI:1710301825
Name:AVON ORTHOTICS & PROSTHETICS
Entity Type:Organization
Organization Name:AVON ORTHOTICS & PROSTHETICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:ANDREW
Authorized Official - Last Name:SHORT
Authorized Official - Suffix:
Authorized Official - Credentials:CPED COF
Authorized Official - Phone:870-351-7974
Mailing Address - Street 1:225 GETTYSBURG
Mailing Address - Street 2:
Mailing Address - City:COATESVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46121-8957
Mailing Address - Country:US
Mailing Address - Phone:870-351-7974
Mailing Address - Fax:
Practice Address - Street 1:6845 E US HIGHWAY 36 STE 450
Practice Address - Street 2:
Practice Address - City:AVON
Practice Address - State:IN
Practice Address - Zip Code:46123-9779
Practice Address - Country:US
Practice Address - Phone:870-351-7974
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-10
Last Update Date:2014-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier