MEDICARE: INSTITUTE FOR PROSTHETIC ADVANCEMENT

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	POR13	FL

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	M2288	OTHER	FL	BCBS PROVIDER ID#

General Provider Information

NPI Number	:	1558345298
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INSTITUTE FOR PROSTHETIC ADVANCEMENT

Provider Business Mailing Address
First Line	:	2315 RUTH HENTZ AVE
Second Line	:
City	:	PANAMA CITY
State	:	FL
Zip	:	32405-2260
Country	:	US
Telephone Number	:	850-784-0320
Fax Number	:	850-784-3661

Provider Business Practice Location Address
First Line	:	2315 RUTH HENTZ AVE
Second Line	:
City	:	PANAMA CITY
State	:	FL
Zip	:	32405-2260
Country	:	US
Telephone Number	:	850-784-0320
Fax Number	:	850-784-3661

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. JOHN C. FREDRICK
Credential	:	CPO
Telephone Number	:	850-784-0320

Provider Enumeration Date	:	12/06/2005
Last Update Date	:	05/09/2012

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Directions to “INSTITUTE FOR PROSTHETIC ADVANCEMENT ” Practice Location

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