Provider Demographics
NPI:1760742274
Name:ORTHOTIC AND PROSTHETIC DESIGNS, LLC
Entity Type:Organization
Organization Name:ORTHOTIC AND PROSTHETIC DESIGNS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:
Authorized Official - Last Name:KEAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:812-372-9002
Mailing Address - Street 1:3200 SYCAMORE CT STE 2B
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:IN
Mailing Address - Zip Code:47203-1552
Mailing Address - Country:US
Mailing Address - Phone:812-372-9002
Mailing Address - Fax:812-372-9088
Practice Address - Street 1:5120 COMMERCE CIR STE 104
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46237-9717
Practice Address - Country:US
Practice Address - Phone:317-882-9002
Practice Address - Fax:317-882-9003
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ORTHOTIC AND PROSTHETIC DESIGNS, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-05-18
Last Update Date:2021-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000306652OtherANTHEM
IN035386POtherSIHO
IN200469430AMedicaid
IN201528OtherCHILDREN'S SPECIAL HEALTH CARE SERVICES
IN200735370AOtherFIRST STEPS
IN200469430AMedicaid