1578541579 NPI number — ARTIFICIAL LIMB SPECIALISTS LLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1578541579 NPI number — ARTIFICIAL LIMB SPECIALISTS LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ARTIFICIAL LIMB SPECIALISTS LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1578541579
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/29/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7600 N 15TH ST
Provider Second Line Business Mailing Address:
STE 105
Provider Business Mailing Address City Name:
PHOENIX
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85020-4330
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
602-745-2080
Provider Business Mailing Address Fax Number:
602-745-2074

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7600 N 15TH ST
Provider Second Line Business Practice Location Address:
SUITE 105
Provider Business Practice Location Address City Name:
PHOENIX
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85020-4330
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
602-745-2080
Provider Business Practice Location Address Fax Number:
602-745-2074
Provider Enumeration Date:
01/09/2006

Additional Information

Authorized Official

Authorized Official Last Name:
PACK
Authorized Official First Name:
MICHAEL
Authorized Official Middle Name:
ALAN
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
602-745-2080

Provider Taxonomy Codes

  • Taxonomy code: 335E00000X , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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