Provider Demographics
NPI:1043379365
Name:LIMB SALVAGE INTERNATIONAL
Entity Type:Organization
Organization Name:LIMB SALVAGE INTERNATIONAL
Other - Org Name:LSI SHOE CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JULIET
Authorized Official - Middle Name:C
Authorized Official - Last Name:BURK
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:918-456-3222
Mailing Address - Street 1:217 N MUSKOGEE AVE
Mailing Address - Street 2:
Mailing Address - City:TAHLEQUAH
Mailing Address - State:OK
Mailing Address - Zip Code:74464-2725
Mailing Address - Country:US
Mailing Address - Phone:918-456-3222
Mailing Address - Fax:918-456-3196
Practice Address - Street 1:1 PLAZA SOUTH ST PMB 140
Practice Address - Street 2:
Practice Address - City:TAHLEQUAH
Practice Address - State:OK
Practice Address - Zip Code:74464-4750
Practice Address - Country:US
Practice Address - Phone:918-458-9888
Practice Address - Fax:918-458-9977
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK201332B00000X
OK202332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
OKDA7676OtherRR MEDICARE GROUP #
KSP00086097OtherRR MEDICARE # DR J BURK
OKP0071200OtherDR R BURK INDIV RR MEDICA
OKDA7676OtherRR MEDICARE GROUP #
OKDA7676OtherRR MEDICARE GROUP #
OKP0071200OtherDR R BURK INDIV RR MEDICA
OK5329300001Medicare NSC