Provider Demographics
NPI:1245278811
Name:PATRIOT ORTHOTIC PRODUCTS LLC
Entity type:Organization
Organization Name:PATRIOT ORTHOTIC PRODUCTS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:D
Authorized Official - Last Name:RAYMOND
Authorized Official - Suffix:
Authorized Official - Credentials:PT, CPED
Authorized Official - Phone:978-794-5528
Mailing Address - Street 1:790 TURNPIKE ST
Mailing Address - Street 2:SUITE 202
Mailing Address - City:NORTH ANDOVER
Mailing Address - State:MA
Mailing Address - Zip Code:01845-6144
Mailing Address - Country:US
Mailing Address - Phone:978-794-5528
Mailing Address - Fax:978-794-5529
Practice Address - Street 1:790 TURNPIKE ST
Practice Address - Street 2:SUITE 202
Practice Address - City:NORTH ANDOVER
Practice Address - State:MA
Practice Address - Zip Code:01845-6144
Practice Address - Country:US
Practice Address - Phone:978-794-5528
Practice Address - Fax:978-794-5529
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA8200611OtherUNITEDHEALTHCARE DME PROV
MA5534490001Medicare NSC