Provider Demographics
NPI:1992779995
Name:MANSFIELD ORTHOTIC AND PROSTHETIC CENTER, INC.
Entity type:Organization
Organization Name:MANSFIELD ORTHOTIC AND PROSTHETIC CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:HOY
Authorized Official - Suffix:
Authorized Official - Credentials:CPO/L FAAOP
Authorized Official - Phone:419-522-4171
Mailing Address - Street 1:240 MARION AVE
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:44903-2115
Mailing Address - Country:US
Mailing Address - Phone:419-522-4171
Mailing Address - Fax:419-525-3269
Practice Address - Street 1:240 MARION AVE
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:OH
Practice Address - Zip Code:44903-2115
Practice Address - Country:US
Practice Address - Phone:419-522-4171
Practice Address - Fax:419-525-3269
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-15
Last Update Date:2007-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHLPO.54335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH5489949Medicaid
OH0242880001Medicare PIN