Provider Demographics
NPI:1316142854
Name:THE ORTHOTIC CENTER, INC
Entity type:Organization
Organization Name:THE ORTHOTIC CENTER, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:M
Authorized Official - Last Name:GREENE
Authorized Official - Suffix:
Authorized Official - Credentials:CO
Authorized Official - Phone:440-528-8222
Mailing Address - Street 1:32333 AURORA RD
Mailing Address - Street 2:
Mailing Address - City:SOLON
Mailing Address - State:OH
Mailing Address - Zip Code:44139-2843
Mailing Address - Country:US
Mailing Address - Phone:440-528-8222
Mailing Address - Fax:440-528-8228
Practice Address - Street 1:1690 WOODLAND DRIVE
Practice Address - Street 2:#200
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43537
Practice Address - Country:US
Practice Address - Phone:800-837-1995
Practice Address - Fax:800-837-1996
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4434706Medicaid