Provider Demographics
NPI:1134121304
Name:ABILENE ARTIFICIAL LIMB CO. LLP
Entity Type:Organization
Organization Name:ABILENE ARTIFICIAL LIMB CO. LLP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER/ CO-OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SHEILA
Authorized Official - Middle Name:D
Authorized Official - Last Name:PHILLIPS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:325-676-8527
Mailing Address - Street 1:1202 HICKORY ST
Mailing Address - Street 2:
Mailing Address - City:ABILENE
Mailing Address - State:TX
Mailing Address - Zip Code:79601-3508
Mailing Address - Country:US
Mailing Address - Phone:325-676-8527
Mailing Address - Fax:325-676-1840
Practice Address - Street 1:1202 HICKORY ST
Practice Address - Street 2:
Practice Address - City:ABILENE
Practice Address - State:TX
Practice Address - Zip Code:79601-3508
Practice Address - Country:US
Practice Address - Phone:325-676-8527
Practice Address - Fax:325-676-1840
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-01
Last Update Date:2022-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX101150335E00000X, 335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes335E00000XSuppliersProsthetic/Orthotic SupplierGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX086716003Medicaid
TX086716003Medicaid