MEDICARE: GREEN PROSTHETICS & ORTHOTICS LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332BC3200X	Customized Equipment (DME)
2	335E00000X	Prosthetic/Orthotic Supplier	6000005987	PA
3	332B00000X	Durable Medical Equipment & Medical Supplies

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1013951441
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GREEN PROSTHETICS & ORTHOTICS LLC

Provider Business Mailing Address
First Line	:	279 NORTH ST
Second Line	:
City	:	MEADVILLE
State	:	PA
Zip	:	16335-2521
Country	:	US
Telephone Number	:	814-337-1159
Fax Number	:	814-337-7710

Provider Business Practice Location Address
First Line	:	279 NORTH ST
Second Line	:
City	:	MEADVILLE
State	:	PA
Zip	:	16335-2521
Country	:	US
Telephone Number	:	814-337-1159
Fax Number	:	814-337-7710

Authorized Official
Title or Position	:	CEO
Name	:	MR. RAKESH JAIN
Credential	:
Telephone Number	:	201-774-1085

Provider Enumeration Date	:	06/15/2006
Last Update Date	:	04/26/2024

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