MEDICARE: PROSTHETIC HOME SERVICES 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	CP002723	DE

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	:	1346420742
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PROSTHETIC HOME SERVICES INC

Provider Business Mailing Address
First Line	:	10654 MAIN ST
Second Line	:
City	:	CLARENCE
State	:	NY
Zip	:	14031-1704
Country	:	US
Telephone Number	:	716-759-9111
Fax Number	:	716-759-9112

Provider Business Practice Location Address
First Line	:	10654 MAIN ST
Second Line	:
City	:	CLARENCE
State	:	NY
Zip	:	14031-1704
Country	:	US
Telephone Number	:	716-759-9111
Fax Number	:	716-759-9112

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. MARK ZUCHLEWSKI
Credential	:	CP
Telephone Number	:	716-759-9111

Provider Enumeration Date	:	11/14/2007
Last Update Date	:	11/12/2008

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