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General NPI Number Information
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NPI Number | 1114507290
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Entity Type | Organization
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Legal Business Name | MERCADO ORTHOTICS & PROSTHETICS
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Dates
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Enumeration Date | 04/12/2021
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Last Update Date | 01/25/2022
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Provider Practice Location Address
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Address Line | 399 FARMINGTON AVE SUITE LL1
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City | FARMINGTON
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State | CT
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Zip | 06032-1937
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Country | US
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Telephone | 833-888-0057
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Fax | 413-750-9916
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Provider Business Mailing Address
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Address Line | PO BOX 15108
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City | SPRINGFIELD
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State | MA
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Zip | 01115-5108
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Country | US
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Telephone | 413-923-7233
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Fax | 413-750-9916
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Authorized Official
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Title or Position | OWNER
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Name | MRS. AUDREY EDITH MOORE
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Credential |
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Telephone | 413-923-7233
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 335E00000X
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Taxonomy Name | Prosthetic/Orthotic Supplier
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License Number |
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License Number State |
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