1003946195 NPI number — MEDICAL ART PROSTHETICS, 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 1003946195 NPI number — MEDICAL ART PROSTHETICS, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MEDICAL ART PROSTHETICS, 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:
1003946195
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/18/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7818 BIG SKY DR
Provider Second Line Business Mailing Address:
SUITE 111
Provider Business Mailing Address City Name:
MADISON
Provider Business Mailing Address State Name:
WI
Provider Business Mailing Address Postal Code:
53719-3524
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
608-833-7002
Provider Business Mailing Address Fax Number:
608-833-7090

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7818 BIG SKY DR STE 111
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MADISON
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
53719-4983
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
608-833-7002
Provider Business Practice Location Address Fax Number:
608-893-6404
Provider Enumeration Date:
03/07/2007

Additional Information

Authorized Official

Authorized Official Last Name:
GION
Authorized Official First Name:
GREGORY
Authorized Official Middle Name:
GAFFNEY
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
608-833-7002

Provider Taxonomy Codes

  • Taxonomy code: 229N00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 41753500 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 086930701 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1003946195 . This is a "NPI FOR WISCONSIN" identifier , issued by the state of ( WI ) . This identifiers is of the category "OTHER".
  • Identifier: 1932295987 . This is a "NPI FOR TEXAS FACILITY" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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