NPIMap

Organization Active NPI

SRT Prosthetics & Orthotics LLC

  • Prosthetic/Orthotic Supplier
  • McHenry, IL
National Provider Identifier
1497929434
Registry record updated Feb 18, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Prosthetic/Orthotic SupplierTaxonomy code 335E00000X
Legal business name
SRT PROSTHETICS & ORTHOTICS LLC
Practice address
406 N. Front St.
Suite F
McHenry, IL 60050
Phone
(815) 679-6900
Fax
(419) 633-3961
NPI assigned
Apr 22, 2008
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 18, 2019

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

Authorized official

Name
Leslie Siebenaler
Title
Director of Operations
Phone
(866) 633-3961

Specialties & licenses 1

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

Addresses

Primary practice location

406 N. Front St.
Suite F
McHenry, IL 60050

Mailing address

408 E Washington St
Butler, IN 46721-1179
Phone (419) 633-3961

Other identifiers 1

IdentifierTypeStateIssuer
04932217OtherILBCBS

National Provider Directory

National Provider Directory

Locations

406 Front St
Ste F
McHenry, IL 60050
Phone (815) 679-6900

3818 W Jefferson Blvd
Fort Wayne, IN 46804
Phone (260) 432-8886

618 N High School Rd
Ste B
Indianapolis, IN 46214
Phone (317) 347-4222

1607 W High St
Bryan, OH 43506
Phone (419) 539-7701

1101 Ralston Ave
Defiance, OH 43512
Phone (419) 782-0393

5220 S 27th St
Milwaukee, WI 53221
Phone (414) 810-3301

Practitioners & affiliated clinicians

Practitioners 6

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1208822400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1550448000000",
    "number": "1497929434",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "408 E WASHINGTON ST",
            "city": "BUTLER",
            "state": "IN",
            "postal_code": "467211179",
            "telephone_number": "419-633-3961",
            "fax_number": "419-633-3981"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "406 N. FRONT ST.",
            "address_2": "SUITE F",
            "city": "MCHENRY",
            "state": "IL",
            "postal_code": "60050",
            "telephone_number": "815-679-6900",
            "fax_number": "419-633-3961"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SRT PROSTHETICS & ORTHOTICS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-04-22",
        "last_updated": "2019-02-18",
        "status": "A",
        "authorized_official_last_name": "SIEBENALER",
        "authorized_official_first_name": "LESLIE",
        "authorized_official_title_or_position": "DIRECTOR OF OPERATIONS",
        "authorized_official_telephone_number": "866-633-3961"
    },
    "taxonomies": [
        {
            "code": "335E00000X",
            "taxonomy_group": "",
            "desc": "Prosthetic/Orthotic Supplier",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "04932217",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in McHenry, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 18, 2019; 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.