MEDICARE: ORTHOTIC PROSTHETIC CENTER 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

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
2	1023974	OTHER	WI	UNITED HEALTHCARE ACM

General Provider Information

NPI Number	:	1548326440
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ORTHOTIC PROSTHETIC CENTER INC

Provider Business Mailing Address
First Line	:	5310 W CAPITOL DR
Second Line	:	SUITE 106
City	:	MILWAUKEE
State	:	WI
Zip	:	53216-2263
Country	:	US
Telephone Number	:	414-875-9000
Fax Number	:	414-875-9001

Provider Business Practice Location Address
First Line	:	5310 W CAPITOL DR
Second Line	:	SUITE 106
City	:	MILWAUKEE
State	:	WI
Zip	:	53216-2263
Country	:	US
Telephone Number	:	414-875-9000
Fax Number	:	414-875-9001

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. CHARLES HALL
Credential	:	C.O.
Telephone Number	:	414-875-9000

Provider Enumeration Date	:	12/28/2006
Last Update Date	:	08/22/2020

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