Provider Demographics
NPI:1427167352
Name:ACTION BRACE & PROSTHETIC, INC.
Entity type:Organization
Organization Name:ACTION BRACE & PROSTHETIC, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:W
Authorized Official - Last Name:HAGEMEIER
Authorized Official - Suffix:
Authorized Official - Credentials:CPO, C PED
Authorized Official - Phone:317-347-4222
Mailing Address - Street 1:5942 W 71ST ST
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46278-1728
Mailing Address - Country:US
Mailing Address - Phone:317-347-4222
Mailing Address - Fax:317-347-4227
Practice Address - Street 1:5942 W 71ST ST
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46278-1728
Practice Address - Country:US
Practice Address - Phone:317-347-4222
Practice Address - Fax:317-347-4227
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-30
Last Update Date:2008-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200204200AMedicaid
IN1246730001Medicare ID - Type Unspecified
1246730001Medicare NSC