=====================================================
General NPI Number Information
=====================================================
NPI Number | 1568868628
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | UNION ORTHOTICS & PROSTHETICS CO.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/17/2014
-----------------------------------------------------
Last Update Date | 02/17/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 161 WATERDAM RD APT 140
-----------------------------------------------------
City | CANONSBURG
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 15317-2572
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 724-941-4285
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3424 LIBERTY AVE
-----------------------------------------------------
City | PITTSBURGH
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 15201-1323
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 412-622-2020
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | ANN L MOSS
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 412-325-2650
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 335E00000X
-----------------------------------------------------
Taxonomy Name | Prosthetic/Orthotic Supplier
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------