Provider Demographics
NPI:1932799707
Name:ORTHOTICS & PROSTHETICS LABORATORIES, INC.
Entity type:Organization
Organization Name:ORTHOTICS & PROSTHETICS LABORATORIES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:HAAS
Authorized Official - Suffix:
Authorized Official - Credentials:CO
Authorized Official - Phone:413-737-2404
Mailing Address - Street 1:300 BIRNIE AVE STE 303
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01107-1379
Mailing Address - Country:US
Mailing Address - Phone:413-737-2404
Mailing Address - Fax:
Practice Address - Street 1:580 COURT ST
Practice Address - Street 2:
Practice Address - City:KEENE
Practice Address - State:NH
Practice Address - Zip Code:03431-1718
Practice Address - Country:US
Practice Address - Phone:888-432-5488
Practice Address - Fax:413-733-1389
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-25
Last Update Date:2021-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0153470001Medicaid