Provider Demographics
NPI:1194728147
Name:BADER PROSTHETICS & ORTHOTICS, INC
Entity type:Organization
Organization Name:BADER PROSTHETICS & ORTHOTICS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:WADE
Authorized Official - Middle Name:
Authorized Official - Last Name:BADER
Authorized Official - Suffix:
Authorized Official - Credentials:CPO
Authorized Official - Phone:813-962-6100
Mailing Address - Street 1:125 CHAPMAN RD E
Mailing Address - Street 2:
Mailing Address - City:LUTZ
Mailing Address - State:FL
Mailing Address - Zip Code:33549-8106
Mailing Address - Country:US
Mailing Address - Phone:813-962-6100
Mailing Address - Fax:
Practice Address - Street 1:125 CHAPMAN RD E
Practice Address - Street 2:
Practice Address - City:LUTZ
Practice Address - State:FL
Practice Address - Zip Code:33549-8106
Practice Address - Country:US
Practice Address - Phone:813-962-6100
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-05-23
Last Update Date:2008-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPOR53335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLM2130OtherBLUE CROSS BLUE SHIELD #
FL218107OtherAMERIGROUP
FL0489170001Medicare NSC