Provider Demographics
NPI:1457351785
Name:PERRY PROSTHETICS, INC.
Entity type:Organization
Organization Name:PERRY PROSTHETICS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:A
Authorized Official - Last Name:PERRY
Authorized Official - Suffix:
Authorized Official - Credentials:CP, LP
Authorized Official - Phone:419-872-7336
Mailing Address - Street 1:970 W. SOUTH BOUNDARY
Mailing Address - Street 2:
Mailing Address - City:PERRYSBURG
Mailing Address - State:OH
Mailing Address - Zip Code:43551-5232
Mailing Address - Country:US
Mailing Address - Phone:419-872-7336
Mailing Address - Fax:419-872-7460
Practice Address - Street 1:970 W SOUTH BOUNDARY ST
Practice Address - Street 2:
Practice Address - City:PERRYSBURG
Practice Address - State:OH
Practice Address - Zip Code:43551-5232
Practice Address - Country:US
Practice Address - Phone:419-872-7336
Practice Address - Fax:419-872-7460
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-28
Last Update Date:2021-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHLP-0088335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2210137Medicaid
OH2210137Medicaid