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NPI Code Detail

MEDICARE: ORTHOTIC AND PROSTHETIC LAB, INC.

MEDICARE: ORTHOTIC AND PROSTHETIC LAB, 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
1332B00000XDurable Medical Equipment & Medical Supplies
2335E00000XProsthetic/Orthotic Supplier211.000024IL
3335E00000XProsthetic/Orthotic Supplier213.000099IL

Other Identifiers

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

General Provider Information

NPI Number : 1235139528
Entity Type Code : Organization
Provider Name (Legal Business Name) : ORTHOTIC AND PROSTHETIC LAB, INC.
Provider Business Mailing Address
First Line : 748 MARSHALL AVE
Second Line :
City : WEBSTER GROVES
State : MO
Zip : 63119-1924
Country : US
Telephone Number : 314-968-8555
Fax Number :
Provider Business Practice Location Address
First Line : 748 MARSHALL AVE
Second Line :
City : WEBSTER GROVES
State : MO
Zip : 63119-1924
Country : US
Telephone Number : 314-968-8555
Fax Number :
Authorized Official
Title or Position : PRESIDENT
Name : MR. DAVID J OSTERMAN
Credential :
Telephone Number : 314-968-8555
Provider Enumeration Date : 07/28/2005
Last Update Date : 02/16/2017

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