Healthcare Provider Details

I. General information

NPI: 1265562011
Provider Name (Legal Business Name): ENDURACARE ORTHOTIC & PROSTHETIC SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/07/2007
Last Update Date: 12/28/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2001 WATERDAM PLAZA DR SUITE 208
MC MURRAY PA
15317-5416
US

IV. Provider business mailing address

2001 WATERDAM PLAZA DR SUITE 208
MC MURRAY PA
15317-5416
US

V. Phone/Fax

Practice location:
  • Phone: 724-941-8821
  • Fax: 724-941-8831
Mailing address:
  • Phone: 724-941-8821
  • Fax: 724-941-8831

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number State

VIII. Authorized Official

Name: MR. MICHAEL PAUL SERENARI
Title or Position: PRESIDENT / CEO
Credential: C.O., B.O.C.O.
Phone: 724-350-0457