Provider Demographics
NPI:1942201918
Name:EAST LIVERPOOL ORTHOTIC PROSTHETIC CLINIC
Entity Type:Organization
Organization Name:EAST LIVERPOOL ORTHOTIC PROSTHETIC CLINIC
Other - Org Name:OPC
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:J
Authorized Official - Last Name:PADEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:330-385-6303
Mailing Address - Street 1:49141 CALCUTTA SMITH FERRY RD
Mailing Address - Street 2:
Mailing Address - City:CALCUTTA
Mailing Address - State:OH
Mailing Address - Zip Code:43920-9002
Mailing Address - Country:US
Mailing Address - Phone:330-385-6303
Mailing Address - Fax:330-385-8849
Practice Address - Street 1:49141 CALCUTTA SMITH FERRY RD
Practice Address - Street 2:
Practice Address - City:CALCUTTA
Practice Address - State:OH
Practice Address - Zip Code:43920-9002
Practice Address - Country:US
Practice Address - Phone:330-385-6303
Practice Address - Fax:330-385-8849
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-02
Last Update Date:2009-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV146809000Medicaid
OH0698482Medicaid
OH0365220001Medicare NSC
OH0365220001Medicare ID - Type UnspecifiedREGION B
OH0365220001Medicare ID - Type UnspecifiedREGION A
0365220001Medicare PIN