Provider Demographics
NPI:1750356945
Name:SWANSON ORTHOTICS & PROSTHETICS CENTER, INC.
Entity type:Organization
Organization Name:SWANSON ORTHOTICS & PROSTHETICS CENTER, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:DENNIS
Authorized Official - Middle Name:J
Authorized Official - Last Name:FITZPATRICK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:610-644-7824
Mailing Address - Street 1:735 S SHOOP AVE
Mailing Address - Street 2:SUITE 3
Mailing Address - City:WAUSEON
Mailing Address - State:OH
Mailing Address - Zip Code:43567-1735
Mailing Address - Country:US
Mailing Address - Phone:419-335-6400
Mailing Address - Fax:419-335-6700
Practice Address - Street 1:735 S SHOOP AVE
Practice Address - Street 2:SUITE 3
Practice Address - City:WAUSEON
Practice Address - State:OH
Practice Address - Zip Code:43567-1735
Practice Address - Country:US
Practice Address - Phone:419-335-6400
Practice Address - Fax:419-335-6700
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH1250740003Medicare ID - Type UnspecifiedMEDICARE PROVIDER #