Organization
INSTITUTE FOR PROSTHETIC ADVANCEMENT
Active
Other names
I.P.A. Prosthetics & Orthotics
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JOHN C. FREDRICK CPO (PRESIDENT)
(850) 784-0320
Entity
Organization
Contact information
Practice address
2315 RUTH HENTZ AVE, PANAMA CITY, FL 32405-2260
(850) 784-0320
(850) 784-3661
Mailing address
2315 RUTH HENTZ AVE, PANAMA CITY, FL 32405-2260
(850) 784-0320
(850) 784-3661
Taxonomy
Speciality
Code
Description
License number
State
335E00000X
Prosthetic/Orthotic Supplier
Primary
POR13
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
951062100
—
FL
01
—
M2288
BCBS PROVIDER ID#
FL
Enumeration date
12/06/2005
Last updated
05/09/2012
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