Provider Demographics
NPI:1235311697
Name:ADA ARTIFICIAL LIMB & BRACE INC.
Entity Type:Organization
Organization Name:ADA ARTIFICIAL LIMB & BRACE INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/LPO
Authorized Official - Prefix:
Authorized Official - First Name:GERALD
Authorized Official - Middle Name:
Authorized Official - Last Name:FAULKNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:580-332-7275
Mailing Address - Street 1:2727 ARLINGTON ST
Mailing Address - Street 2:
Mailing Address - City:ADA
Mailing Address - State:OK
Mailing Address - Zip Code:74820-2908
Mailing Address - Country:US
Mailing Address - Phone:580-332-7275
Mailing Address - Fax:580-332-4838
Practice Address - Street 1:2727 ARLINGTON ST
Practice Address - Street 2:
Practice Address - City:ADA
Practice Address - State:OK
Practice Address - Zip Code:74820-2908
Practice Address - Country:US
Practice Address - Phone:580-332-7275
Practice Address - Fax:580-332-4838
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-28
Last Update Date:2007-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK25335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK731432989-001OtherBLUE CROSS BLUE SHIELD
OK0522300001Medicare NSC