Prosthetic Orthotic Center Lte

Primary specialty

Prosthetic/Orthotic SupplierTaxonomy code 335E00000X

Legal business name

PROSTHETIC ORTHOTIC CENTER LTE

Practice address

1108 S 17TH Ave
Wausau, WI 54401-5709

Phone

(715) 845-2800

Fax

(715) 845-2855

NPI assigned

Aug 31, 2006

Organization subpart

No

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

Authorized official

Name

Elizabeth Ruth Lotz, CFM, RFM

Title

Owner/ V.P.

Phone

(715) 845-2800

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Pink Ribbon Mastectomy Boutique Doing business as

Medicare fee-for-service enrollment

Enrolled in WI

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

Medicare medical equipment & supply locations

Locations

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

{
    "created_epoch": "1156982400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1373414400000",
    "number": "1801907217",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1108 S 17TH AVE",
            "city": "WAUSAU",
            "state": "WI",
            "postal_code": "544015709",
            "telephone_number": "715-845-2800",
            "fax_number": "715-845-2855"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1108 S 17TH AVE",
            "city": "WAUSAU",
            "state": "WI",
            "postal_code": "544015709",
            "telephone_number": "715-845-2800",
            "fax_number": "715-845-2855"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROSTHETIC ORTHOTIC CENTER LTE",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-31",
        "last_updated": "2013-07-10",
        "status": "A",
        "authorized_official_last_name": "LOTZ",
        "authorized_official_first_name": "ELIZABETH",
        "authorized_official_middle_name": "RUTH",
        "authorized_official_title_or_position": "OWNER/ V.P.",
        "authorized_official_telephone_number": "715-845-2800",
        "authorized_official_credential": "CFM, RFM"
    },
    "taxonomies": [
        {
            "code": "335E00000X",
            "taxonomy_group": "",
            "desc": "Prosthetic/Orthotic Supplier",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "41782800",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Pink Ribbon Mastectomy Boutique",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Joseph J Prillwitz, LPC
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• Karen T. Prochaska, LPC-SAS
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• Brian Damien Puent, MS OD
• Margo J Quinn, M.D.
• Quirt Family Dentistry, SC
• Radiology Associates of Wausau, SC

• Prosthetic/Orthotic Supplier in Wausau, WI
• Providers in Wausau, WI by specialty
• Prosthetic/Orthotic Supplier in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 10, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.