Provider Demographics
NPI:1144417072
Name:ABLE II PROSTHETICS AND ORTHOTICS
Entity Type:Organization
Organization Name:ABLE II PROSTHETICS AND ORTHOTICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CPO
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:A
Authorized Official - Last Name:PIRO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:402-483-8898
Mailing Address - Street 1:PO BOX 22832
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68542-2832
Mailing Address - Country:US
Mailing Address - Phone:402-483-8898
Mailing Address - Fax:402-435-5504
Practice Address - Street 1:506 1ST AVE SE
Practice Address - Street 2:
Practice Address - City:WATERTOWN
Practice Address - State:SD
Practice Address - Zip Code:57201-4402
Practice Address - Country:US
Practice Address - Phone:605-882-0432
Practice Address - Fax:605-882-0978
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-25
Last Update Date:2020-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1744P3200XOther Service ProvidersSpecialistProsthetics Case ManagementGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD4999175OtherBCBS
SD1160090001Medicare NSC