Provider Demographics
NPI:1891943577
Name:PRO-ORTHOTICS INC
Entity Type:Organization
Organization Name:PRO-ORTHOTICS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:OVIDIU
Authorized Official - Middle Name:
Authorized Official - Last Name:GEORGESCU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:708-645-4801
Mailing Address - Street 1:62 ORLAND SQUARE DR STE 7
Mailing Address - Street 2:
Mailing Address - City:ORLAND PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60462-6561
Mailing Address - Country:US
Mailing Address - Phone:708-645-4801
Mailing Address - Fax:708-590-0945
Practice Address - Street 1:62 ORLAND SQUARE DR STE 7
Practice Address - Street 2:
Practice Address - City:ORLAND PARK
Practice Address - State:IL
Practice Address - Zip Code:60462-6561
Practice Address - Country:US
Practice Address - Phone:708-645-4801
Practice Address - Fax:708-590-0945
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-05
Last Update Date:2019-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
6312640001Medicare NSC