Provider Demographics
NPI:1427114362
Name:ORTHOTIC & PROSTHETIC SPECIALTIES, INC.
Entity type:Organization
Organization Name:ORTHOTIC & PROSTHETIC SPECIALTIES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE-PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:R
Authorized Official - Last Name:HECKMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:216-531-2773
Mailing Address - Street 1:20650 LAKELAND BLVD
Mailing Address - Street 2:
Mailing Address - City:EUCLID
Mailing Address - State:OH
Mailing Address - Zip Code:44119-3241
Mailing Address - Country:US
Mailing Address - Phone:216-531-2773
Mailing Address - Fax:216-531-5376
Practice Address - Street 1:11100 EUCLID AVE
Practice Address - Street 2:UNIVERSITY HOSPITALS BOLWELL #5014
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44106-1716
Practice Address - Country:US
Practice Address - Phone:216-531-2773
Practice Address - Fax:216-531-5376
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH00000155387OtherANTHEM
OH0209983Medicaid
OH0209983Medicaid
OH=========026OtherCARESOURCE
OH0170060001Medicare ID - Type Unspecified