MEDICARE: CARDINAL PROSTHETICS & 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	POR 54	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	M2531	OTHER	FL	BCBS

General Provider Information

NPI Number	:	1528069192
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CARDINAL PROSTHETICS & ORTHOTICS INC

Provider Business Mailing Address
First Line	:	779 TAMIAMI TRAIL
Second Line	:	STE 8
City	:	PORT CHARLOTTE
State	:	FL
Zip	:	33953
Country	:	US
Telephone Number	:	941-235-0252
Fax Number	:	941-235-7273

Provider Business Practice Location Address
First Line	:	779 TAMIAMI TRAIL
Second Line	:	STE 8
City	:	PORT CHARLOTTE
State	:	FL
Zip	:	33953
Country	:	US
Telephone Number	:	941-235-0252
Fax Number	:	941-235-7273

Authorized Official
Title or Position	:	PRESIDENT AND OWNER
Name	:	MR. STEVEN LAWRENCE FRIES
Credential	:	LPO
Telephone Number	:	941-235-7273

Provider Enumeration Date	:	08/09/2005
Last Update Date	:	08/22/2020

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