Provider Demographics
NPI:1982884433
Name:LEHOTAY PROSTHETICS, LLC
Entity Type:Organization
Organization Name:LEHOTAY PROSTHETICS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ADAM
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:LEHOTAY
Authorized Official - Suffix:
Authorized Official - Credentials:CP
Authorized Official - Phone:304-344-0036
Mailing Address - Street 1:624 CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25302-1912
Mailing Address - Country:US
Mailing Address - Phone:304-344-0036
Mailing Address - Fax:304-344-5025
Practice Address - Street 1:624 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25302-1912
Practice Address - Country:US
Practice Address - Phone:304-344-0036
Practice Address - Fax:304-344-5025
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-13
Last Update Date:2020-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV6301016000Medicaid
WV3969850001Medicare NSC