Provider Demographics
NPI:1770579690
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:OWNER/PRACTIONER
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:L
Authorized Official - Last Name:GROPE
Authorized Official - Suffix:
Authorized Official - Credentials:LPO
Authorized Official - Phone:330-792-6826
Mailing Address - Street 1:6431 MAHONING AVE
Mailing Address - Street 2:
Mailing Address - City:AUSTINTOWN
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 1:6431 MAHONING AVE
Practice Address - Street 2:
Practice Address - City:AUSTINTOWN
Practice Address - State:OH
Practice Address - Zip Code:44515-2039
Practice Address - Country:US
Practice Address - Phone:330-792-6826
Practice Address - Fax:330-792-8493
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-26
Last Update Date:2020-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2229225Medicaid
OH2229225Medicaid
OH4228050001Medicare ID - Type Unspecified