1235194341 NPI number — POSITIVE IMAGE PROSTHETICS & ORTHOTICS, INC.

Table of content: (NPI 1235194341)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1235194341 NPI number — POSITIVE IMAGE PROSTHETICS & ORTHOTICS, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
POSITIVE IMAGE 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:
1235194341
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/03/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
POSITIVE IMAGE PROSTHETICS & ORTHOTICS, INC.
Provider Second Line Business Mailing Address:
5202 WATERS AVE.
Provider Business Mailing Address City Name:
SAVANNAH
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
31404-6230
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
912-354-7500
Provider Business Mailing Address Fax Number:
912-354-7887

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
POSITIVE IMAGE PROSTHETICS & ORTHOTICS, INC.
Provider Second Line Business Practice Location Address:
5202 WATERS AVE.
Provider Business Practice Location Address City Name:
SAVANNAH
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
31404-6230
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
912-354-7500
Provider Business Practice Location Address Fax Number:
912-354-7887
Provider Enumeration Date:
04/20/2006

Additional Information

Authorized Official

Authorized Official Last Name:
PUCKETT
Authorized Official First Name:
DAVID
Authorized Official Middle Name:
M
Authorized Official Title or Position:
PRESIDENT/OWNER
Authorized Official Telephone Number:
912-354-7500

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)

  • Identifier: 000844698A , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 003212044A , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: DE1986 , issued by the state of ( SC ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com