Provider Demographics
NPI:1427115955
Name:ROCCO PROSTHETIC AND ORTHOTIC CENTER INC
Entity type:Organization
Organization Name:ROCCO PROSTHETIC AND ORTHOTIC CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/BUSINESS MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:KURT
Authorized Official - Middle Name:R
Authorized Official - Last Name:ROCCO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:513-281-2800
Mailing Address - Street 1:2375 FLORENCE AVE
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45206-2466
Mailing Address - Country:US
Mailing Address - Phone:513-281-2800
Mailing Address - Fax:513-281-0420
Practice Address - Street 1:2375 FLORENCE AVE
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45206-2466
Practice Address - Country:US
Practice Address - Phone:513-281-2800
Practice Address - Fax:513-281-0420
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-03
Last Update Date:2015-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH199335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY90254939Medicaid
KY000000016760OtherANTHEM
OH0900716Medicaid
OH=========006OtherMEDICAL MUTUAL
OH=========026OtherCARE SOURCE
OH0613470001Medicare ID - Type UnspecifiedREGION B
KY000000016760OtherANTHEM