Healthcare Provider Details

I. General information

NPI: 1154328078
Provider Name (Legal Business Name): ORTHO-TEC MEDICAL, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/07/2005
Last Update Date: 03/04/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15 GORE ROAD
WEBSTER MA
01570-6834
US

IV. Provider business mailing address

P.O. BOX 364
WEBSTER MA
01570-0364
US

V. Phone/Fax

Practice location:
  • Phone: 888-616-9811
  • Fax: 888-616-9812
Mailing address:
  • Phone: 888-616-9811
  • Fax: 888-616-9812

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number State

VIII. Authorized Official

Name: MR. DAVID HAYNES
Title or Position: PRESIDENT
Credential:
Phone: 888-616-9811