Provider Demographics
NPI:1871747931
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 / OWNER
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, CPED
Authorized Official - Phone:302-369-9476
Mailing Address - Street 1:4092 N DUPONT HWY
Mailing Address - Street 2:
Mailing Address - City:DOVER
Mailing Address - State:DE
Mailing Address - Zip Code:19901-1522
Mailing Address - Country:US
Mailing Address - Phone:302-369-9476
Mailing Address - Fax:302-744-9279
Practice Address - Street 1:4092 N DUPONT HWY
Practice Address - Street 2:
Practice Address - City:DOVER
Practice Address - State:DE
Practice Address - Zip Code:19901-1522
Practice Address - Country:US
Practice Address - Phone:302-369-9476
Practice Address - Fax:302-744-9279
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-15
Last Update Date:2024-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DE2008206929335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE5915790002Medicare NSC