Provider Demographics
NPI:1003946195
Name:MEDICAL ART PROSTHETICS, LLC
Entity Type:Organization
Organization Name:MEDICAL ART PROSTHETICS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:GAFFNEY
Authorized Official - Last Name:GION
Authorized Official - Suffix:
Authorized Official - Credentials:CCA
Authorized Official - Phone:608-833-7002
Mailing Address - Street 1:7818 BIG SKY DR
Mailing Address - Street 2:SUITE 111
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53719-3524
Mailing Address - Country:US
Mailing Address - Phone:608-833-7002
Mailing Address - Fax:608-833-7090
Practice Address - Street 1:7818 BIG SKY DR
Practice Address - Street 2:SUITE 111
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53719-3524
Practice Address - Country:US
Practice Address - Phone:608-833-7002
Practice Address - Fax:608-833-7090
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-07
Last Update Date:2009-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes229N00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersAnaplastologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX086930701Medicaid
WI41753500Medicaid
WI1003946195OtherNPI FOR WISCONSIN
TX1932295987OtherNPI FOR TEXAS FACILITY
TX086930701Medicaid
WI5058300002Medicare NSC