MEDICARE: PROSTHETIC LABORATORIES OF ROCHESTER 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

General Provider Information

NPI Number	:	1851382691
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PROSTHETIC LABORATORIES OF ROCHESTER INC

Provider Business Mailing Address
First Line	:	2829 POST RD
Second Line	:
City	:	STEVENS POINT
State	:	WI
Zip	:	54481-6416
Country	:	US
Telephone Number	:	715-344-9328
Fax Number	:	715-344-9385

Provider Business Practice Location Address
First Line	:	2829 POST RD
Second Line	:
City	:	STEVENS POINT
State	:	WI
Zip	:	54481-6416
Country	:	US
Telephone Number	:	715-344-9328
Fax Number	:	715-344-9385

Authorized Official
Title or Position	:	CEO
Name	:	MR. BRIAN GREEN
Credential	:
Telephone Number	:	507-281-5250

Provider Enumeration Date	:	11/01/2005
Last Update Date	:	07/03/2012

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