MEDICARE: LEIMKUEHLER ORTHOTIC-PROSTHETIC CENTER, INC.

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	224P00000X	Prosthetist	LP0065	OH
2	222Z00000X	Orthotist	LP0072	OH
3	335E00000X	Prosthetic/Orthotic Supplier

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

General Provider Information

NPI Number	:	1154323558
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LEIMKUEHLER ORTHOTIC-PROSTHETIC CENTER, INC.

Provider Business Mailing Address
First Line	:	205 N LEAVITT RD
Second Line	:
City	:	AMHERST
State	:	OH
Zip	:	44001-1124
Country	:	US
Telephone Number	:	440-988-5770
Fax Number	:	440-988-5776

Provider Business Practice Location Address
First Line	:	205 N LEAVITT RD
Second Line	:
City	:	AMHERST
State	:	OH
Zip	:	44001-1124
Country	:	US
Telephone Number	:	440-988-5770
Fax Number	:	440-988-5776

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. WILLIAM JOHN LEIMKUEHLER SR.
Credential	:	CPO
Telephone Number	:	440-988-5770

Provider Enumeration Date	:	08/15/2005
Last Update Date	:	12/03/2021

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