MEDICARE: KIDDER ORTHOPEDIC LABORATORIES 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	POR20	FL
2	335E00000X	Prosthetic/Orthotic Supplier	POR193	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	M2080	OTHER	BCBS
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1376542993
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KIDDER ORTHOPEDIC LABORATORIES INC

Provider Business Mailing Address
First Line	:	5676 W GULF TO LAKE HWY
Second Line	:
City	:	CRYSTAL RIVER
State	:	FL
Zip	:	34429-7555
Country	:	US
Telephone Number	:	352-795-5556
Fax Number	:	352-795-5218

Provider Business Practice Location Address
First Line	:	5676 W GULF TO LAKE HWY
Second Line	:
City	:	CRYSTAL RIVER
State	:	FL
Zip	:	34429-7555
Country	:	US
Telephone Number	:	352-795-5556
Fax Number	:	352-795-5218

Authorized Official
Title or Position	:	OWNER
Name	:	JOHN E MESSER
Credential	:	CPO, LPO
Telephone Number	:	352-795-5556

Provider Enumeration Date	:	07/15/2005
Last Update Date	:	12/27/2010

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Directions to “KIDDER ORTHOPEDIC LABORATORIES INC ” Practice Location

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