Provider Demographics
NPI:1871775668
Name:O & P CLINICAL TECHNOLOGIES, INC.
Entity type:Organization
Organization Name:O & P CLINICAL TECHNOLOGIES, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:E
Authorized Official - Last Name:PRUSAKOWSKI
Authorized Official - Suffix:
Authorized Official - Credentials:LPO, CPO, FAAOP
Authorized Official - Phone:352-331-4221
Mailing Address - Street 1:4650 NW 39TH AVE STE G
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32606-6090
Mailing Address - Country:US
Mailing Address - Phone:352-331-4221
Mailing Address - Fax:352-332-8074
Practice Address - Street 1:4650 NW 39TH AVE STE G
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32606-6090
Practice Address - Country:US
Practice Address - Phone:352-331-4221
Practice Address - Fax:352-332-8074
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-03
Last Update Date:2025-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPOR56332BC3200X, 335E00000X, 335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
000849796OOtherABC
6MYL2OtherCAGE
NB7TG45GY7L5OtherSAM
FL952053800Medicaid