1003378217 NPI number — PA ARTIFICIAL LIMB & BRACE CO., INC

Table of content: (NPI 1003378217)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1003378217 NPI number — PA ARTIFICIAL LIMB & BRACE CO., INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PA ARTIFICIAL LIMB & BRACE CO., 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:
1003378217
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/05/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
224 W 26TH ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ERIE
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
16508-1806
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
814-868-5231
Provider Business Mailing Address Fax Number:
814-868-5232

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
917 WASHINGTON ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
JAMESTOWN
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
14701-3044
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
888-457-9637
Provider Business Practice Location Address Fax Number:
814-868-5232
Provider Enumeration Date:
04/05/2019

Additional Information

Authorized Official

Authorized Official Last Name:
SVETZ
Authorized Official First Name:
STEPHEN
Authorized Official Middle Name:
J
Authorized Official Title or Position:
ADMINISTRATOR
Authorized Official Telephone Number:
814-868-5231

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • 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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