Provider Demographics
NPI:1154657948
Name:LIMB SALVAGE INTERNATIONAL, INC
Entity Type:Organization
Organization Name:LIMB SALVAGE INTERNATIONAL, INC
Other - Org Name:LSI CLINICS (LSI FOOT, SHOE, WOUND OR ORTHOTICS)
Other - Org Type:Doing Business As
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
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:918-931-1425
Mailing Address - Street 1:1 PLAZA SOUTH ST
Mailing Address - Street 2:PMB 140
Mailing Address - City:TAHLEQUAH
Mailing Address - State:OK
Mailing Address - Zip Code:74464-4750
Mailing Address - Country:US
Mailing Address - Phone:918-458-9888
Mailing Address - Fax:918-458-9977
Practice Address - Street 1:2210 N 14TH ST
Practice Address - Street 2:
Practice Address - City:PONCA CITY
Practice Address - State:OK
Practice Address - Zip Code:74604
Practice Address - Country:US
Practice Address - Phone:580-718-0002
Practice Address - Fax:580-718-0003
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-29
Last Update Date:2009-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK23029208D00000X
OK201213ES0103X
332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Multi-Specialty
No208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Multi-Specialty