Provider Demographics
NPI:1801195540
Name:O & P CLINICAL TECHNOLOGIES, INC.
Entity Type:Organization
Organization Name:O & P CLINICAL TECHNOLOGIES, INC.
Other - Org Name:PINNACLE ORTHOTIC & PROSTHETIC SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:E
Authorized Official - Last Name:PRUSAKOWSKI
Authorized Official - Suffix:
Authorized Official - Credentials:LPO, CPO, FAAOP
Authorized Official - Phone:352-331-4221
Mailing Address - Street 1:5959 SHALLOWFORD RD STE 215
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37421-2215
Mailing Address - Country:US
Mailing Address - Phone:423-648-4898
Mailing Address - Fax:423-499-4979
Practice Address - Street 1:5959 SHALLOWFORD RD STE 215
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37421-2215
Practice Address - Country:US
Practice Address - Phone:423-648-4898
Practice Address - Fax:423-499-4979
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-21
Last Update Date:2020-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA000053332B00000X
TN121332BC3200X
TN100335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1524374Medicaid
75VX6OtherCAGE
034877323OtherDUNS