Provider Demographics
NPI:1811018609
Name:CAPITAL PROSTHETIC AND ORTHOTIC CENTER, INC.
Entity Type:Organization
Organization Name:CAPITAL PROSTHETIC AND ORTHOTIC CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:LISA
Authorized Official - Middle Name:J
Authorized Official - Last Name:CRAWFORD
Authorized Official - Suffix:
Authorized Official - Credentials:OWNER
Authorized Official - Phone:614-451-0446
Mailing Address - Street 1:4678 LARWELL DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43220-3621
Mailing Address - Country:US
Mailing Address - Phone:614-451-0446
Mailing Address - Fax:614-451-2126
Practice Address - Street 1:4678 LARWELL DR
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43220-3621
Practice Address - Country:US
Practice Address - Phone:614-451-0446
Practice Address - Fax:614-451-2126
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-02
Last Update Date:2020-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHLPO 60332BC3200X, 335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0482759Medicaid
OH0482759Medicaid