Provider Demographics
NPI:1306919808
Name:CUSTOM FITS O & P SERVICES INC
Entity type:Organization
Organization Name:CUSTOM FITS O & P SERVICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:CHRISTOPHER
Authorized Official - Last Name:THIGPEN
Authorized Official - Suffix:
Authorized Official - Credentials:CO LCPED
Authorized Official - Phone:954-721-7301
Mailing Address - Street 1:8401 W MCNAB ROAD
Mailing Address - Street 2:
Mailing Address - City:TAMARAC
Mailing Address - State:FL
Mailing Address - Zip Code:33321
Mailing Address - Country:US
Mailing Address - Phone:954-721-7301
Mailing Address - Fax:954-721-7453
Practice Address - Street 1:8401 W MCNAB ROAD
Practice Address - Street 2:
Practice Address - City:TAMARAC
Practice Address - State:FL
Practice Address - Zip Code:33321
Practice Address - Country:US
Practice Address - Phone:954-721-7301
Practice Address - Fax:954-721-7453
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
1047364OtherCAREPLUS
50540OtherNEIGHBORHOOD HEALTH
M2678OtherBCBS
POS7973523OtherHMO
10582OtherTOTAL HEALTH CHOICE
3475892OtherAETNA
50540OtherNEIGHBORHOOD HEALTH
50540OtherNEIGHBORHOOD HEALTH