Provider Demographics
NPI:1134164544
Name:ORTHOTIC AND PROSTHETIC CENTER OF BOSTON, LLC
Entity type:Organization
Organization Name:ORTHOTIC AND PROSTHETIC CENTER OF BOSTON, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:TIERNEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:508-775-2570
Mailing Address - Street 1:126B MID TECH DR
Mailing Address - Street 2:
Mailing Address - City:WEST YARMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02673-2560
Mailing Address - Country:US
Mailing Address - Phone:508-775-2570
Mailing Address - Fax:508-775-7609
Practice Address - Street 1:126B MID TECH DR
Practice Address - Street 2:
Practice Address - City:WEST YARMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02673-2560
Practice Address - Country:US
Practice Address - Phone:508-775-2570
Practice Address - Fax:508-775-7609
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ORTHOTIC AND PROSTHETIC CENTER OF BOSTON, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-06-19
Last Update Date:2018-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
0039938OtherNEIGHBORHOOD HEALTH PLAN
AA89184OtherHARVARD PILGRIM HEALTH CA
MA1530381Medicaid
1362065OtherAETNA
1362065OtherAETNA
960939OtherNETWORK HEALTH
0039938OtherNEIGHBORHOOD HEALTH PLAN
1362065OtherAETNA