Provider Demographics
NPI:1154585651
Name:TOTAL BODY ORTHOTICS CENTER, INC.
Entity type:Organization
Organization Name:TOTAL BODY ORTHOTICS CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:BORIS
Authorized Official - Middle Name:
Authorized Official - Last Name:VAKS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:330-793-8205
Mailing Address - Street 1:5437 MAHONING AVE
Mailing Address - Street 2:SUITE 5
Mailing Address - City:AUSTINTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44515-2437
Mailing Address - Country:US
Mailing Address - Phone:330-793-8205
Mailing Address - Fax:330-793-8357
Practice Address - Street 1:5437 MAHONING AVE
Practice Address - Street 2:SUITE 5
Practice Address - City:AUSTINTOWN
Practice Address - State:OH
Practice Address - Zip Code:44515-2437
Practice Address - Country:US
Practice Address - Phone:330-793-8205
Practice Address - Fax:330-793-8357
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-14
Last Update Date:2009-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
No335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH6209310001Medicare NSC