CENTER FOR ORTHOTIC & PROSTHETIC EXCELLENCE, LLC (NPI# 1346424728) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
Nation Provider ID (NPI) | 1346424728 |
Entity Type | Organization |
Organization Name | CENTER FOR ORTHOTIC & PROSTHETIC EXCELLENCE, LLC |
Practice Address |
9615 Keilman St Suite 200 Saint John IN 46373 |
Mailing Address |
741 W Main Street Peoria IL 61606 |
Practice Telephone | 2193650248 |
Practice Fax Number | 2193650072 |
Mailing Telephone | 3096762276 |
Mailing Fax Number | 8886636322 |
Enumeration Date | 2007-12-20 |
Last Update Date | 2018-07-30 |
Authorized Official Name | MR. DONALD GOERTZEN (PRESIDENT) |
Authorized Official Telephone | 3096762276 |
Authorized Official Credential | CPO |
Is Organization Subpart | N |
Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
---|---|---|---|---|---|
Y | 335E00000X | Prosthetic/Orthotic Supplier | IN | Suppliers |
State | Issuer | Identifier | Type Code |
---|---|---|---|
IL | STATE OF ILLINOIS - LICENSED ORTHOTIST | 213.000102 | 01 |
IN | AMERICAN BOARD FOR CERTIFICATION IN ORTHOTICS & PROSTHETICS | CO003904 | 01 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1275847246 | Center for Orthotic & Prosthetic Excellence, LLC | Prosthetic/Orthotic Supplier | 2213 Main St Unit 1c-102, Highland, IN 46322-3514 | 2010-08-02 |
Street Address |
9615 KEILMAN ST SUITE 200 |
City | SAINT JOHN |
State | IN |
Zip Code | 46373 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1669472270 | Great Lakes Orthopedics & Sports Medicine, PC | Podiatrist | 9615 Keilman St, Saint John, IN 46373-9406 | 2005-07-26 |
1639648322 | Mariah Nicole Isaacs | Physician Assistant | 9615 Keilman St, Saint John, IN 46373-9406 | 2018-11-26 |
1548764376 | Great Lakes Orthopedics Physical Therapy P.C. | Physical Therapist | 9615 Keilman St, Saint John, IN 46373-9406 | 2018-03-19 |
1558613547 | Timothy Brian Williams | Physician Assistant | 9615 Keilman St, Saint John, IN 46373-9406 | 2012-10-15 |
1851682561 | Natasha Mandula | Podiatrist | 9615 Keilman St, Saint John, IN 46373-9406 | 2011-04-28 |
1659699890 | Rehabilitation & Musculoskeletal Medicine Specialist, LLC | Physical Medicine & Rehabilitation | 9615 Keilman St, Saint John, IN 46373-9406 | 2010-05-12 |
1972521771 | Linda Kristina | Physical Therapist | 9615 Keilman St, Saint John, IN 46373-9406 | 2006-07-18 |
1821039389 | Richard E Mcclain | Orthopaedic Surgery | 9615 Keilman St, Saint John, IN 46373-9406 | 2006-06-08 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1023641123 | Lisa A Arteaga | Occupational Therapy Assistant | 10700 Park Place of St John, St John, IN 46373 | 2020-02-17 |
1306493507 | Athletico Ltd | Physical Therapist | 10081 Wicker Ave #4, Saint John, IN 46373 | 2019-08-22 |
1083014971 | Courtney Olavarria | Registered Nurse | 8915 West 93rd Avenue, Clark Middle School, Saint John, IN 46373 | 2014-08-27 |
1316368111 | Tracy Lynn Wargo | Registered Nurse | 8801 Wicker Ave., Kolling Elementary, St. John, IN 46373 | 2013-12-20 |
1245587989 | Joshua Dejong | Physical Therapist | 10200 Wicker Ave Ste 1, Saint John, IN 46373 | 2012-08-13 |
1053406629 | Corlin Alden Stein | Chiropractor | 9161 Wicker Avenue (us 41), St. John, IN 46373 | 2006-10-03 |
1235190216 | Tarak R Chokshi | Internal Medicine | 10200 Wicker Avenue, St John, IN 46373 | 2006-03-30 |
1154397057 | Norbert A Matulis | Dentist | 9207 Wicker Avenue, St John, IN 46373 | 2006-02-28 |
1568462729 | Keith R. Pitchford | Orthopaedic Surgery | 9615 Keilman Street, Saint John, IN 46373 | 2005-07-28 |
1528483021 | Creating Smiles PC | Dentist | 8217 Wicker Ave, St John, IN 46373 | 2014-02-20 |
Find all providers in zip 46373 |
Taxonomy Code | 335E00000X |
Grouping | Suppliers |
Classification | Prosthetic/Orthotic Supplier |
An organization that provides prosthetic and orthotic care which may include, but is not limited to, patient evaluation, prosthesis or orthosis design, fabrication, fitting and modification to treat limb loss for purposes of restoring physiological function and/or cosmesis or to treat a neuromusculoskeletal disorder or acquired condition. |
Notes: Source: American Board for Certification in Orthotics, Prosthetics, and Pedorthics, Inc. [7/1/2010: modified, 7/1/2013: modified] Additional Resources: American Board for Certification in Orthotics, Prosthetics and Pedorthics, Inc., www.abcop.org and Board of Certification/Accreditation, International, www.bocusa.org. |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1639781081 | Kenney Orthopedics Indianapolis, LLC | Prosthetic/Orthotic Supplier | 1801 N Senate Blvd Ste 420, Indianapolis, IN 46202-1228 | 2020-08-18 |
1982220109 | Bionic Prosthetics and Orthotics Group LLC | Prosthetic/Orthotic Supplier | 3647 Clifty Dr, Madison, IN 47250-1649 | 2020-06-23 |
1154941557 | Radiance Renewed | Prosthetic/Orthotic Supplier | 9445 Indianapolis Blvd Ste 1042, Highland, IN 46322-2648 | 2020-04-26 |
1295397735 | Orthopedic and Sports Medicine Center of Northern Indiana, Inc | Prosthetic/Orthotic Supplier | 200 E Jackson Blvd Ste 130, Elkhart, IN 46516-3513 | 2019-07-05 |
1710465166 | Cranial Technologies Inc | Prosthetic/Orthotic Supplier | 10603 N Meridian St Ste 120, Indianapolis, IN 46290-1055 | 2018-07-29 |
1285135913 | Excel Orthotics and Prosthetics LLC | Prosthetic/Orthotic Supplier | 3200 Sycamore Ct Ste 2b, Columbus, IN 47203-1552 | 2018-02-27 |
1003326174 | Bionic Prosthetics and Orthotics Group LLC | Prosthetic/Orthotic Supplier | 3130a Windsor Ct, Elkhart, IN 46514-5556 | 2017-10-03 |
1285144352 | Bionic Prosthetics and Orthotics Group LLC | Prosthetic/Orthotic Supplier | 1101 Glendale Blvd Ste 105, Valparaiso, IN 46383-3769 | 2017-10-03 |
1669904579 | Jordan Poynter | Prosthetic/Orthotic Supplier | 3708 S Lafountain St, Kokomo, IN 46902-3805 | 2017-03-30 |
1184156101 | Shawn Dee Brown | Prosthetic/Orthotic Supplier | 2410 N Glendale Dr Ste C, Fort Wayne, IN 46804-8909 | 2017-03-29 |
Find all providers with the same taxonomy |
City | SAINT JOHN |
Zip Code | 46373 |
Please comment or provide details below to improve the information on CENTER FOR ORTHOTIC & PROSTHETIC EXCELLENCE, LLC.
Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.