Provider Demographics
NPI:1265049092
Name:WESTERN RESERVE ORTHOTICS PROSTHETICS CENTRE INC
Entity type:Organization
Organization Name:WESTERN RESERVE ORTHOTICS PROSTHETICS CENTRE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATIVE SUPERVISOR
Authorized Official - Prefix:
Authorized Official - First Name:DEANNA
Authorized Official - Middle Name:
Authorized Official - Last Name:PALOWITZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:330-792-6826
Mailing Address - Street 1:6431 MAHONING AVE
Mailing Address - Street 2:
Mailing Address - City:YOUNGSTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44515-2039
Mailing Address - Country:US
Mailing Address - Phone:330-792-6826
Mailing Address - Fax:330-792-8493
Practice Address - Street 1:243 THREE SPRINGS DR STE 14A
Practice Address - Street 2:
Practice Address - City:WEIRTON
Practice Address - State:WV
Practice Address - Zip Code:26062-3885
Practice Address - Country:US
Practice Address - Phone:330-792-6826
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-25
Last Update Date:2024-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2229225Medicaid
OH4228050001OtherMEDICARE