NPIMap

Organization Active NPI

Intercoastal Orthotics & Prosthetics, LLC

  • Prosthetic/Orthotic Supplier
  • Edgewater, FL
National Provider Identifier
1083839062
Registry record updated Aug 3, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Prosthetic/Orthotic SupplierTaxonomy code 335E00000X
License
POR 162 Issued in FL
Legal business name
INTERCOASTAL ORTHOTICS & PROSTHETICS, LLC
Practice address
1 Pelican Dr Ste a
Edgewater, FL 32141-4254
Phone
(386) 409-9432
Fax
(386) 409-9433
NPI assigned
Apr 16, 2007
Last updated
Aug 3, 2009By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 3, 2009

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mr. Tom Harvey Mowery, CPO,LPONPI 1912031154
Title
Prosthetist, Orthotist
Phone
(386) 409-9432

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Prosthetic/Orthotic Supplier 335E00000X POR 162 FL Primary

Addresses

Primary practice location

1 Pelican Dr Ste a
Edgewater, FL 32141-4254

Mailing address

1 Pelican Dr Ste a
Edgewater, FL 32141-4254
Phone (386) 409-9432

Other identifiers 1

IdentifierTypeStateIssuer
M2714OtherFLBLUE CROSS PROVIDER #

National Provider Directory

National Provider Directory

Locations

1 Pelican Dr
Ste A
Edgewater, FL 32141
Phone (386) 409-9432

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1176681600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1249257600000",
    "number": "1083839062",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1 PELICAN DR STE A",
            "city": "EDGEWATER",
            "state": "FL",
            "postal_code": "321414254",
            "telephone_number": "386-409-9432",
            "fax_number": "386-409-9433"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1 PELICAN DR STE A",
            "city": "EDGEWATER",
            "state": "FL",
            "postal_code": "321414254",
            "telephone_number": "386-409-9432",
            "fax_number": "386-409-9433"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INTERCOASTAL ORTHOTICS & PROSTHETICS, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-16",
        "last_updated": "2009-08-03",
        "status": "A",
        "authorized_official_last_name": "MOWERY",
        "authorized_official_first_name": "TOM",
        "authorized_official_middle_name": "HARVEY",
        "authorized_official_title_or_position": "PROSTHETIST, ORTHOTIST",
        "authorized_official_telephone_number": "386-409-9432",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "CPO,LPO"
    },
    "taxonomies": [
        {
            "code": "335E00000X",
            "taxonomy_group": "",
            "desc": "Prosthetic/Orthotic Supplier",
            "state": "FL",
            "license": "POR 162",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS PROVIDER #",
            "identifier": "M2714",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Edgewater, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 3, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.