Provider Demographics
NPI:1912324534
Name:ORTHOTIC & PROSTHETIC CARE OF CINCINNATI
Entity Type:Organization
Organization Name:ORTHOTIC & PROSTHETIC CARE OF CINCINNATI
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CERTIFIED ORTHOTIST, LICENSED ORTHO
Authorized Official - Prefix:MR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:
Authorized Official - Last Name:VAUGHN
Authorized Official - Suffix:
Authorized Official - Credentials:CO, LO
Authorized Official - Phone:513-751-6722
Mailing Address - Street 1:2368 VICTORY PKWY
Mailing Address - Street 2:SUITE 100
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45206-2859
Mailing Address - Country:US
Mailing Address - Phone:513-751-6722
Mailing Address - Fax:513-861-6722
Practice Address - Street 1:2368 VICTORY PKWY
Practice Address - Street 2:SUITE 100
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45206-2859
Practice Address - Country:US
Practice Address - Phone:513-751-6722
Practice Address - Fax:513-861-6722
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-20
Last Update Date:2014-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH7069750001Medicare NSC