1528157914 NPI number — LIMBCARE PROSTHETICS & ORTHOTICS LLC.

Table of content: (NPI 1528157914)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1528157914 NPI number — LIMBCARE PROSTHETICS & ORTHOTICS LLC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LIMBCARE PROSTHETICS & ORTHOTICS 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:
1528157914
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1350 LINDBERG DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SLIDELL
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
70458-8054
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
985-726-9052
Provider Business Mailing Address Fax Number:
985-726-9053

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1350 LINDBERG DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SLIDELL
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70458-8054
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
985-726-9052
Provider Business Practice Location Address Fax Number:
985-726-9053
Provider Enumeration Date:
10/12/2006

Additional Information

Authorized Official

Authorized Official Last Name:
RESTIVO
Authorized Official First Name:
EDMOND
Authorized Official Middle Name:
JUDE
Authorized Official Title or Position:
PROSTHETIST/ORTHOTIST
Authorized Official Telephone Number:
985-726-9052

Provider Taxonomy Codes

  • Taxonomy code: 261QM1300X , with the licence number:  CPO02238 , registered in the state of AL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1590304 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".




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