Provider Demographics
NPI:1699771816
Name:NORTH COAST ORTHOTICS AND PROSTHETICS INC
Entity type:Organization
Organization Name:NORTH COAST ORTHOTICS AND PROSTHETICS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:J
Authorized Official - Last Name:YAKOVICH
Authorized Official - Suffix:
Authorized Official - Credentials:CO/LO
Authorized Official - Phone:440-233-4314
Mailing Address - Street 1:6100 S BROADWAY
Mailing Address - Street 2:STE 104
Mailing Address - City:LORAIN
Mailing Address - State:OH
Mailing Address - Zip Code:44053-3875
Mailing Address - Country:US
Mailing Address - Phone:440-233-4314
Mailing Address - Fax:440-233-7526
Practice Address - Street 1:6100 S BROADWAY
Practice Address - Street 2:STE 104
Practice Address - City:LORAIN
Practice Address - State:OH
Practice Address - Zip Code:44053-3875
Practice Address - Country:US
Practice Address - Phone:440-233-4314
Practice Address - Fax:440-233-7526
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-22
Last Update Date:2011-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0766845Medicaid
OH0191650001Medicare NSC