Healthcare Provider Details

I. General information

NPI: 1447226287
Provider Name (Legal Business Name): CENTRAL PA PROSTHETICS/ORTHOTICS, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/23/2006
Last Update Date: 06/19/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

173 S MARKET ST
ELYSBURG PA
17824-9757
US

IV. Provider business mailing address

173 S MARKET ST
ELYSBURG PA
17824-9757
US

V. Phone/Fax

Practice location:
  • Phone: 570-672-4580
  • Fax: 570-672-4581
Mailing address:
  • Phone: 570-672-4580
  • Fax: 570-672-4581

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License NumberPO000182
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number State

VIII. Authorized Official

Name: MR. HOWARD C STOUT
Title or Position: PRESIDENT/OWNER
Credential: CP
Phone: 570-672-4580