MEDICARE: ORTHO-TEC MEDICAL, 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	335E00000X	Prosthetic/Orthotic Supplier
2	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
4	604729	OTHER	MA	TUFTS HEALTH PLAN
5	1154328078	OTHER		TRICARE
6	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
7	370854	OTHER		BCBS OF MASSACHUSETTS
8	1154328078	OTHER	MA	HPHC INSURANCE COMPANY
9	42008	OTHER		FALLON COMMUNITY HEALTH P
10	8200076	OTHER		EVERCARE

General Provider Information

NPI Number	:	1154328078
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ORTHO-TEC MEDICAL, INC.

Provider Business Mailing Address
First Line	:	P.O. BOX 364
Second Line	:
City	:	WEBSTER
State	:	MA
Zip	:	01570-0364
Country	:	US
Telephone Number	:	888-616-9811
Fax Number	:	888-616-9812

Provider Business Practice Location Address
First Line	:	15 GORE ROAD
Second Line	:
City	:	WEBSTER
State	:	MA
Zip	:	01570-6834
Country	:	US
Telephone Number	:	888-616-9811
Fax Number	:	888-616-9812

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. DAVID HAYNES
Credential	:
Telephone Number	:	888-616-9811

Provider Enumeration Date	:	07/07/2005
Last Update Date	:	03/04/2015

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