Provider Demographics
NPI:1548326440
Name:ORTHOTIC PROSTHETIC CENTER INC
Entity type:Organization
Organization Name:ORTHOTIC PROSTHETIC CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:
Authorized Official - Last Name:HALL
Authorized Official - Suffix:
Authorized Official - Credentials:CO
Authorized Official - Phone:414-875-9000
Mailing Address - Street 1:5310 W CAPITOL DR
Mailing Address - Street 2:SUITE 106
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53216-2263
Mailing Address - Country:US
Mailing Address - Phone:414-875-9000
Mailing Address - Fax:414-875-9001
Practice Address - Street 1:5310 W CAPITOL DR
Practice Address - Street 2:SUITE 106
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53216-2263
Practice Address - Country:US
Practice Address - Phone:414-875-9000
Practice Address - Fax:414-875-9001
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI41611500Medicaid
WI1023974OtherUNITED HEALTHCARE ACM
WI1023974OtherUNITED HEALTHCARE ACM