Provider Demographics
NPI:1255397550
Name:PRECISION ORTHOPEDIC TECHNOLOGY, INC.
Entity type:Organization
Organization Name:PRECISION ORTHOPEDIC TECHNOLOGY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:SHANNON
Authorized Official - Middle Name:
Authorized Official - Last Name:KISER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:606-833-9631
Mailing Address - Street 1:PO BOX 937
Mailing Address - Street 2:
Mailing Address - City:FLATWOODS
Mailing Address - State:KY
Mailing Address - Zip Code:41139-0937
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2611 GREENBO BLVD
Practice Address - Street 2:
Practice Address - City:FLATWOODS
Practice Address - State:KY
Practice Address - Zip Code:41139-1830
Practice Address - Country:US
Practice Address - Phone:606-833-9631
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-25
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY90004284Medicaid
OH2288297Medicaid
WV6204016000Medicaid
KY000000218373OtherBC/BS ANTHEM
OH2288297Medicaid
KY5099180001Medicare ID - Type Unspecified