MEDICARE: SRT PROSTHETICS & ORTHOTICS LLC

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

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	21825	OTHER	IN	ABP
2	000000229696	OTHER	IN	ANTHEM
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1508804295
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SRT PROSTHETICS & ORTHOTICS LLC

Provider Business Mailing Address
First Line	:	408 E WASHINGTON ST
Second Line	:
City	:	BUTLER
State	:	IN
Zip	:	46721-1179
Country	:	US
Telephone Number	:	419-633-3961
Fax Number	:	419-633-3981

Provider Business Practice Location Address
First Line	:	3818 W JEFFERSON BLVD
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46804-6840
Country	:	US
Telephone Number	:	260-432-8886
Fax Number	:	260-432-1137

Authorized Official
Title or Position	:	CREDENTIALING MGR.
Name	:	LORI MARLER
Credential	:
Telephone Number	:	615-864-8790

Provider Enumeration Date	:	06/03/2006
Last Update Date	:	05/22/2025

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