Healthcare Provider Details

I. General information

NPI: 1598127490
Provider Name (Legal Business Name): CENTER FOR ORTHOTIC & PROSTHETIC CARE OF SCRANTON, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/22/2016
Last Update Date: 02/10/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 MAIN ST STE 2
OLYPHANT PA
18447-1343
US

IV. Provider business mailing address

1500 MAIN ST STE 2
OLYPHANT PA
18447-1343
US

V. Phone/Fax

Practice location:
  • Phone: 570-382-8208
  • Fax: 570-483-4880
Mailing address:
  • Phone: 570-382-8208
  • Fax: 570-483-4880

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: GRACE ANGELINE
Title or Position: REG COMPLIANCE SPECIALIST III
Credential:
Phone: 714-961-2102