1952852220 NPI number — PROSTHETIC TECHNOLOGIES LLC

Table of content: LAWANDA DENISE GIBBS LMSW (NPI 1821705187)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1952852220 NPI number — PROSTHETIC TECHNOLOGIES LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PROSTHETIC TECHNOLOGIES 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:
1952852220
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/20/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
335 W 9TH ST
Provider Second Line Business Mailing Address:
UNIT 150
Provider Business Mailing Address City Name:
INDIANAPOLIS
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
46202-3121
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:
333 N ALABAMA ST
Provider Second Line Business Practice Location Address:
SUITE 350
Provider Business Practice Location Address City Name:
INDIANAPOLIS
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
46204-2034
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
317-804-4729
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/20/2016

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
O'BRIEN
Authorized Official First Name:
SHAUN
Authorized Official Middle Name:
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
317-804-4729

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)