Provider Demographics
NPI:1780902676
Name:MILLENNIUM PROSTHETIC AND ORTHOTIC INSTITUTE, LLC
Entity type:Organization
Organization Name:MILLENNIUM PROSTHETIC AND ORTHOTIC INSTITUTE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:HERBERT
Authorized Official - Middle Name:GEORGE
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:JR
Authorized Official - Credentials:LPO, CPO
Authorized Official - Phone:727-421-1976
Mailing Address - Street 1:7730 STARKEY RD
Mailing Address - Street 2:
Mailing Address - City:SEMINOLE
Mailing Address - State:FL
Mailing Address - Zip Code:33777-4307
Mailing Address - Country:US
Mailing Address - Phone:727-421-1976
Mailing Address - Fax:
Practice Address - Street 1:7730 STARKEY RD
Practice Address - Street 2:
Practice Address - City:SEMINOLE
Practice Address - State:FL
Practice Address - Zip Code:33777-4307
Practice Address - Country:US
Practice Address - Phone:727-421-1976
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-17
Last Update Date:2011-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPOR81335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL6379300001Medicare NSC