Provider Demographics
NPI:1033690920
Name:EXTREMITY CARE, LLC
Entity Type:Organization
Organization Name:EXTREMITY CARE, LLC
Other - Org Name:EXTREMITY CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:ANDREW
Authorized Official - Last Name:MADDEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:815-382-7462
Mailing Address - Street 1:3901 MAIN STREET, SUITE 101A
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19127
Mailing Address - Country:US
Mailing Address - Phone:888-694-6694
Mailing Address - Fax:800-886-8266
Practice Address - Street 1:3901 MAIN STREET, SUITE 101A
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19127
Practice Address - Country:US
Practice Address - Phone:888-694-6694
Practice Address - Fax:800-886-8266
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-28
Last Update Date:2018-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies