Provider Demographics
NPI:1801994934
Name:ORTHOTIC PROSTHETIC CENTER INC
Entity type:Organization
Organization Name:ORTHOTIC PROSTHETIC CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:D
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:CO
Authorized Official - Phone:941-748-2521
Mailing Address - Street 1:2717 MANATEE AVENUE WEST
Mailing Address - Street 2:
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34205-4939
Mailing Address - Country:US
Mailing Address - Phone:941-748-2521
Mailing Address - Fax:941-749-0864
Practice Address - Street 1:2717 MANATEE AVENUE WEST
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34205-4939
Practice Address - Country:US
Practice Address - Phone:941-748-2521
Practice Address - Fax:941-749-0864
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLORT9222Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes222Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL0374150001Medicare ID - Type Unspecified