Healthcare Provider Details

I. General information

NPI: 1275533424
Provider Name (Legal Business Name): MORGANTOWN ORTHOTIC & PROSTHETIC CENTER, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/29/2005
Last Update Date: 09/17/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7000 HAMPTON CTR SUITE A
MORGANTOWN WV
26505-1720
US

IV. Provider business mailing address

7000 HAMPTON CTR SUITE A
MORGANTOWN WV
26505-1720
US

V. Phone/Fax

Practice location:
  • Phone: 304-598-0528
  • Fax: 304-598-0527
Mailing address:
  • Phone: 304-598-0528
  • Fax: 304-598-0527

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. MARK GORMAN
Title or Position: CO DIRECTOR
Credential: CPO
Phone: 304-598-0528