MEDICARE: ORTHOTIC AND PROSTHETIC CENTER OF BOSTON, 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	335E00000X	Prosthetic/Orthotic Supplier

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
1	0039938	OTHER	NEIGHBORHOOD HEALTH PLAN
2	AA89184	OTHER	HARVARD PILGRIM HEALTH CA
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	1362065	OTHER	AETNA

General Provider Information

NPI Number	:	1134164544
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ORTHOTIC AND PROSTHETIC CENTER OF BOSTON, LLC

Provider Business Mailing Address
First Line	:	126B MID TECH DR
Second Line	:
City	:	WEST YARMOUTH
State	:	MA
Zip	:	02673-2560
Country	:	US
Telephone Number	:	508-775-2570
Fax Number	:	508-775-7609

Provider Business Practice Location Address
First Line	:	126B MID TECH DR
Second Line	:
City	:	WEST YARMOUTH
State	:	MA
Zip	:	02673-2560
Country	:	US
Telephone Number	:	508-775-2570
Fax Number	:	508-775-7609

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. JAMES TIERNEY
Credential	:
Telephone Number	:	508-775-2570

Provider Enumeration Date	:	06/19/2006
Last Update Date	:	11/07/2018

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