1851645949 NPI number — COMPLETE PROSTHETICS & ORTHOTICS, INC.

Table of content: MRS. TAMAR JOY LIBERMAN MS (NPI 1871464362)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1851645949 NPI number — COMPLETE PROSTHETICS & ORTHOTICS, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COMPLETE PROSTHETICS & ORTHOTICS, INC.
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:
1851645949
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/29/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2221 5TH ST N
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
COLUMBUS
Provider Business Mailing Address State Name:
MS
Provider Business Mailing Address Postal Code:
39705-2211
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2221 5TH ST N
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
COLUMBUS
Provider Business Practice Location Address State Name:
MS
Provider Business Practice Location Address Postal Code:
39705-2211
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
662-844-2363
Provider Business Practice Location Address Fax Number:
662-844-2624
Provider Enumeration Date:
10/29/2012

Additional Information

Authorized Official

Authorized Official Last Name:
QUINN
Authorized Official First Name:
CHARLES
Authorized Official Middle Name:
GREGORY
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
662-844-2363

Provider Taxonomy Codes

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

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





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