Provider Demographics
NPI:1184858169
Name:LIMBCARE PROSTHETICS AND ORTHOTICS OF GEORGIA INC
Entity Type:Organization
Organization Name:LIMBCARE PROSTHETICS AND ORTHOTICS OF GEORGIA INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:P
Authorized Official - Last Name:RODMAN
Authorized Official - Suffix:
Authorized Official - Credentials:CPO
Authorized Official - Phone:229-430-9778
Mailing Address - Street 1:511 W FORSYTH ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:AMERICUS
Mailing Address - State:GA
Mailing Address - Zip Code:31709-3465
Mailing Address - Country:US
Mailing Address - Phone:229-924-1620
Mailing Address - Fax:229-924-1623
Practice Address - Street 1:511 W FORSYTH ST
Practice Address - Street 2:SUITE A
Practice Address - City:AMERICUS
Practice Address - State:GA
Practice Address - Zip Code:31709-3465
Practice Address - Country:US
Practice Address - Phone:229-924-1620
Practice Address - Fax:229-924-1623
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-06
Last Update Date:2010-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA6128060003Medicare NSC