Provider Demographics
NPI:1649309972
Name:INDEPENDENCE PROSTHETICS-ORTHOTICS, INC.
Entity type:Organization
Organization Name:INDEPENDENCE PROSTHETICS-ORTHOTICS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:HORNE
Authorized Official - Suffix:
Authorized Official - Credentials:CPO
Authorized Official - Phone:302-369-9476
Mailing Address - Street 1:31 MEADOWOOD DRIVE
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:DE
Mailing Address - Zip Code:19711-7202
Mailing Address - Country:US
Mailing Address - Phone:302-369-9476
Mailing Address - Fax:302-369-9060
Practice Address - Street 1:19160 COASTAL HWY UNIT A
Practice Address - Street 2:
Practice Address - City:REHOBOTH BEACH
Practice Address - State:DE
Practice Address - Zip Code:19971-6110
Practice Address - Country:US
Practice Address - Phone:302-212-5552
Practice Address - Fax:302-212-5514
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-04
Last Update Date:2020-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE5915790001Medicare NSC