MEDICARE: PREFERRED PROSTHETICS AND ORTHOTICS, 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	LPO23	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	000000244821	OTHER	OH	ANTHEM BC/BS
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1306027628
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PREFERRED PROSTHETICS AND ORTHOTICS, INC.

Provider Business Mailing Address
First Line	:	8571 FOXWOOD CT STE C
Second Line	:
City	:	POLAND
State	:	OH
Zip	:	44514-4313
Country	:	US
Telephone Number	:	330-259-0265
Fax Number	:	330-259-0272

Provider Business Practice Location Address
First Line	:	8571 FOXWOOD CT STE C
Second Line	:
City	:	POLAND
State	:	OH
Zip	:	44514-4313
Country	:	US
Telephone Number	:	330-259-0265
Fax Number	:	330-259-0272

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. ANTHONY LOUIS DIBENEDETTO
Credential	:	LPO
Telephone Number	:	330-259-0265

Provider Enumeration Date	:	11/15/2007
Last Update Date	:	11/15/2007

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