MEDICARE: ORTHOTIC & PROSTHETIC CENTERS, INC.

Medicare Provider Information

Scope of Practice

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

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

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	:	1265868517
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ORTHOTIC & PROSTHETIC CENTERS, INC.

Provider Business Mailing Address
First Line	:	3611 5TH AVE N
Second Line	:
City	:	ST PETERSBURG
State	:	FL
Zip	:	33713-7503
Country	:	US
Telephone Number	:	727-327-3332
Fax Number	:	727-327-7304

Provider Business Practice Location Address
First Line	:	4245 KINGS HWY UNIT C
Second Line	:
City	:	PORT CHARLOTTE
State	:	FL
Zip	:	33980-8416
Country	:	US
Telephone Number	:	941-235-3332
Fax Number	:	941-875-9192

Authorized Official
Title or Position	:	DIRECTOR OF FINANCE & OPERATIONS
Name	:	CHRISTINA GELAZNIK
Credential	:
Telephone Number	:	727-498-1003

Provider Enumeration Date	:	09/18/2013
Last Update Date	:	11/15/2022

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