MEDICARE: CENTRAL OHIO ORTHOTIC & PROSTHETIC CTR 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	000000155144	OTHER	OH	ANTHEM BCBS

General Provider Information

NPI Number	:	1669471009
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CENTRAL OHIO ORTHOTIC & PROSTHETIC CTR INC

Provider Business Mailing Address
First Line	:	3059 E MOUND ST
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43209-2665
Country	:	US
Telephone Number	:	614-231-4256
Fax Number	:	614-231-0127

Provider Business Practice Location Address
First Line	:	3059 E MOUND ST
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43209-2665
Country	:	US
Telephone Number	:	614-231-4256
Fax Number	:	614-231-0127

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. BARRY P FOWLER SR.
Credential	:	ORTHOTIST/PROSTHETIS
Telephone Number	:	614-231-4256

Provider Enumeration Date	:	07/19/2005
Last Update Date	:	08/22/2020

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