Provider Demographics
NPI:1679895395
Name:LEIMKUEHLER ORTHOTIC & PROSTHETIC CENTER INC.
Entity type:Organization
Organization Name:LEIMKUEHLER ORTHOTIC & PROSTHETIC CENTER INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:LEIMKUEHLER
Authorized Official - Suffix:SR
Authorized Official - Credentials:CPO
Authorized Official - Phone:440-988-5770
Mailing Address - Street 1:205 N. LEAVITT RD.
Mailing Address - Street 2:
Mailing Address - City:AMHERST
Mailing Address - State:OH
Mailing Address - Zip Code:44001
Mailing Address - Country:US
Mailing Address - Phone:440-988-5770
Mailing Address - Fax:440-988-5776
Practice Address - Street 1:762 US 250 E.
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:OH
Practice Address - Zip Code:44805
Practice Address - Country:US
Practice Address - Phone:419-281-9373
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-22
Last Update Date:2010-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHL0-0072222Z00000X
OHLP-0065224P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetistGroup - Multi-Specialty
No222Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0830293Medicaid