Provider Demographics
NPI:1083736672
Name:AMERICAN LIMB AND ORTHOTIC CENTER, INC
Entity Type:Organization
Organization Name:AMERICAN LIMB AND ORTHOTIC CENTER, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TERESA
Authorized Official - Middle Name:K
Authorized Official - Last Name:THORPE
Authorized Official - Suffix:
Authorized Official - Credentials:CO
Authorized Official - Phone:773-685-4998
Mailing Address - Street 1:5800 W HIGGINS AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60630-2023
Mailing Address - Country:US
Mailing Address - Phone:773-685-4998
Mailing Address - Fax:773-685-5155
Practice Address - Street 1:5800 W HIGGINS AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60630-2023
Practice Address - Country:US
Practice Address - Phone:773-685-4998
Practice Address - Fax:773-685-5155
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL01632158OtherBLUE CROSS BLUE SHIELD IL
IL01632158OtherBLUE CROSS BLUE SHIELD IL
IL=========001Medicaid