Provider Demographics
NPI:1023213295
Name:ADVANCED PROSTHETIC SERVICES, INC.
Entity Type:Organization
Organization Name:ADVANCED PROSTHETIC SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROSTHETIST
Authorized Official - Prefix:MS
Authorized Official - First Name:ELLA
Authorized Official - Middle Name:BETH
Authorized Official - Last Name:DURHAM
Authorized Official - Suffix:
Authorized Official - Credentials:CPO
Authorized Official - Phone:501-368-0868
Mailing Address - Street 1:2930 E MOORE AVE
Mailing Address - Street 2:
Mailing Address - City:SEARCY
Mailing Address - State:AR
Mailing Address - Zip Code:72143-4831
Mailing Address - Country:US
Mailing Address - Phone:501-368-0868
Mailing Address - Fax:501-368-0003
Practice Address - Street 1:2930 E MOORE AVE
Practice Address - Street 2:
Practice Address - City:SEARCY
Practice Address - State:AR
Practice Address - Zip Code:72143-4831
Practice Address - Country:US
Practice Address - Phone:501-368-0868
Practice Address - Fax:501-368-0003
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-18
Last Update Date:2015-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR157554716Medicaid
AR157554716Medicaid