Provider Demographics
NPI:1831688746
Name:ORTHOTIC & PROSTHETIC CENTERS, INC.
Entity type:Organization
Organization Name:ORTHOTIC & PROSTHETIC CENTERS, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF FINANCE & OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTINA
Authorized Official - Middle Name:
Authorized Official - Last Name:GELAZNIK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:727-498-1003
Mailing Address - Street 1:3611 5TH AVE N
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33713-7503
Mailing Address - Country:US
Mailing Address - Phone:727-327-3332
Mailing Address - Fax:
Practice Address - Street 1:407 W HIGHLAND BLVD
Practice Address - Street 2:
Practice Address - City:INVERNESS
Practice Address - State:FL
Practice Address - Zip Code:34452-4717
Practice Address - Country:US
Practice Address - Phone:352-634-8228
Practice Address - Fax:352-419-0582
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-07
Last Update Date:2022-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL101599400Medicaid