Provider Demographics
NPI:1093766081
Name:ALLAN ARTIFICIAL LIMBS
Entity Type:Organization
Organization Name:ALLAN ARTIFICIAL LIMBS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CERTIFIED PROSTHETIST/OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ALLAN
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:SCHULZE
Authorized Official - Suffix:
Authorized Official - Credentials:CP
Authorized Official - Phone:217-221-8991
Mailing Address - Street 1:926 BROADWAY ST
Mailing Address - Street 2:SUITE 3
Mailing Address - City:QUINCY
Mailing Address - State:IL
Mailing Address - Zip Code:62301-2730
Mailing Address - Country:US
Mailing Address - Phone:217-221-8991
Mailing Address - Fax:217-221-8982
Practice Address - Street 1:926 BROADWAY ST
Practice Address - Street 2:SUITE 3
Practice Address - City:QUINCY
Practice Address - State:IL
Practice Address - Zip Code:62301-2730
Practice Address - Country:US
Practice Address - Phone:217-221-8991
Practice Address - Fax:217-221-8982
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-13
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL211-000154335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL074309OtherRIVERQUEST DMEPOS
IL00132016OtherBC/BS DMEPOS
MO626049209Medicaid
IL00132016OtherBC/BS DMEPOS
MO626049209Medicaid