Provider Demographics
NPI:1902284938
Name:INDEPENDENCE PROSTHETICS-ORTHOTICS, INC.
Entity Type:Organization
Organization Name:INDEPENDENCE PROSTHETICS-ORTHOTICS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:R
Authorized Official - Last Name:HORNE
Authorized Official - Suffix:
Authorized Official - Credentials:CPO
Authorized Official - Phone:302-369-9476
Mailing Address - Street 1:31 MEADOWOOD DR
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:DE
Mailing Address - Zip Code:19711-7202
Mailing Address - Country:US
Mailing Address - Phone:302-369-9476
Mailing Address - Fax:302-369-9060
Practice Address - Street 1:550 S COLLEGE AVE
Practice Address - Street 2:SUITE 111
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19716-1307
Practice Address - Country:US
Practice Address - Phone:302-894-9476
Practice Address - Fax:302-894-9477
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-11
Last Update Date:2016-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE1649309972Medicare NSC
DE5915790006Medicare PIN
DE5915790006Medicare NSC