Provider Demographics
NPI:1194891325
Name:ADVANCE ORTHOTIC & PROSTHETIC SERVICES, INC.
Entity type:Organization
Organization Name:ADVANCE ORTHOTIC & PROSTHETIC SERVICES, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OPERATION MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:APRIL
Authorized Official - Middle Name:
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:207-786-7022
Mailing Address - Street 1:270 NORTH RIVER ROAD
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:ME
Mailing Address - Zip Code:04210
Mailing Address - Country:US
Mailing Address - Phone:207-786-7022
Mailing Address - Fax:207-777-1787
Practice Address - Street 1:277 BATH ROAD
Practice Address - Street 2:
Practice Address - City:BRUNSWICK
Practice Address - State:ME
Practice Address - Zip Code:04011
Practice Address - Country:US
Practice Address - Phone:207-443-5996
Practice Address - Fax:207-442-0943
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-28
Last Update Date:2025-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME132230000Medicaid
ME132230000Medicaid