Provider Demographics
NPI:1811167190
Name:PROSTHETIC & ORTHOTIC ASSOCIATES
Entity type:Organization
Organization Name:PROSTHETIC & ORTHOTIC ASSOCIATES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:C
Authorized Official - Last Name:MCKINLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:859-260-8576
Mailing Address - Street 1:455 S WASHINGTON ST
Mailing Address - Street 2:SUITE 11
Mailing Address - City:GETTYSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17325-2516
Mailing Address - Country:US
Mailing Address - Phone:717-337-2273
Mailing Address - Fax:717-337-2285
Practice Address - Street 1:220 MOREHEAD PLZ
Practice Address - Street 2:
Practice Address - City:MOREHEAD
Practice Address - State:KY
Practice Address - Zip Code:40351-1591
Practice Address - Country:US
Practice Address - Phone:606-783-0103
Practice Address - Fax:606-784-2152
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-03
Last Update Date:2011-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY5732070002Medicare NSC