Provider Demographics
NPI:1841265485
Name:CAPE PROSTHETICS-ORTHOTICS, INC.
Entity type:Organization
Organization Name:CAPE PROSTHETICS-ORTHOTICS, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:VP & SECRETARY
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:E
Authorized Official - Last Name:TARVIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:717-972-1100
Mailing Address - Street 1:912 IDA ST
Mailing Address - Street 2:
Mailing Address - City:POPLAR BLUFF
Mailing Address - State:MO
Mailing Address - Zip Code:63901-4210
Mailing Address - Country:US
Mailing Address - Phone:573-778-9093
Mailing Address - Fax:573-778-9094
Practice Address - Street 1:912 IDA ST
Practice Address - Street 2:
Practice Address - City:POPLAR BLUFF
Practice Address - State:MO
Practice Address - Zip Code:63901-4210
Practice Address - Country:US
Practice Address - Phone:573-778-9093
Practice Address - Fax:573-778-9094
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-17
Last Update Date:2017-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO628641607Medicaid
MO0186280004Medicare NSC