Canton Orthotic Laboratory Inc

Primary specialty

Prosthetic/Orthotic SupplierTaxonomy code 335E00000X

Legal business name

CANTON ORTHOTIC LABORATORY INC

Practice address

811 12TH St NW
Canton, OH 44703-1927

Phone

(330) 454-2081

Fax

(330) 454-9568

NPI assigned

Jun 1, 2005

Organization subpart

No

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

Authorized official

Name

Mr. Stephen Thomas Simko, LO

Title

President/Licensed Orthotist

Phone

(330) 454-2081

Specialties & licenses 2

Addresses

Other identifiers 2

Tax ID family

Canton Orthotic Laboratory Inc2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Canton Orthotic Laboratory Inc

  • Prosthetic/Orthotic Supplier
  • Massillon, OH
  • NPI 1073576617
  NPD tax ID

Locations

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

{
    "created_epoch": "1117584000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1720080005",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "811 12TH ST NW",
            "city": "CANTON",
            "state": "OH",
            "postal_code": "447031927",
            "telephone_number": "330-454-2081",
            "fax_number": "330-454-9568"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "811 12TH ST NW",
            "city": "CANTON",
            "state": "OH",
            "postal_code": "447031927",
            "telephone_number": "330-454-2081",
            "fax_number": "330-454-9568"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CANTON ORTHOTIC LABORATORY INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-06-01",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "SIMKO",
        "authorized_official_first_name": "STEPHEN",
        "authorized_official_middle_name": "THOMAS",
        "authorized_official_title_or_position": "PRESIDENT/LICENSED ORTHOTIST",
        "authorized_official_telephone_number": "330-454-2081",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "LO"
    },
    "taxonomies": [
        {
            "code": "335E00000X",
            "taxonomy_group": "",
            "desc": "Prosthetic/Orthotic Supplier",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "335E00000X",
            "taxonomy_group": "",
            "desc": "Prosthetic/Orthotic Supplier",
            "state": "OH",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM PROVIDER NUMBER",
            "identifier": "000000155415",
            "state": "OH"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0291143",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Canton Friendship Center, Inc.
• Canton General Surgery Associates, Inc.
• Canton Injury Center LLC
• Canton Internal Medicine Associates Ince
• Canton Ophthalmology Associates, Inc.
• Canton Pathology Associates, Inc.
• Canton Pediatric Dental Center
• Canton Primary Care & Hospital Medicine, Inc..
• Canton Rehabilitation and Nursing Center LLC (Hall of Fame Rehabilitation and Nursing Center)
• Canton Smiles, Inc

• Prosthetic/Orthotic Supplier in Canton, OH
• Providers in Canton, OH by specialty
• Prosthetic/Orthotic Supplier in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.