Provider Demographics
NPI:1053811174
Name:CENTRAL ORTHOTICS LLC
Entity type:Organization
Organization Name:CENTRAL ORTHOTICS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ORTHOTIST/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JON
Authorized Official - Middle Name:RICHARD
Authorized Official - Last Name:TAPIO
Authorized Official - Suffix:
Authorized Official - Credentials:BOCO
Authorized Official - Phone:906-376-8000
Mailing Address - Street 1:431 FRONT ST
Mailing Address - Street 2:
Mailing Address - City:REPUBLIC
Mailing Address - State:MI
Mailing Address - Zip Code:49879-9100
Mailing Address - Country:US
Mailing Address - Phone:906-376-8000
Mailing Address - Fax:616-884-8119
Practice Address - Street 1:431 FRONT ST
Practice Address - Street 2:
Practice Address - City:REPUBLIC
Practice Address - State:MI
Practice Address - Zip Code:49879-9100
Practice Address - Country:US
Practice Address - Phone:906-376-8000
Practice Address - Fax:616-884-8119
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-02-15
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5306004871335E00000X
BOCS60682335E00000X
335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
1336683358OtherNPI