Provider Demographics
NPI:1235424177
Name:RELIANT PROSTHETICS SOUTHWEST, LLC
Entity Type:Organization
Organization Name:RELIANT PROSTHETICS SOUTHWEST, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:MR
Authorized Official - First Name:TOM
Authorized Official - Middle Name:L
Authorized Official - Last Name:LOPOSER
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:972-470-0300
Mailing Address - Street 1:1300 COUNTRY CLUB RD
Mailing Address - Street 2:SUITE B
Mailing Address - City:SANTA TERESA
Mailing Address - State:NM
Mailing Address - Zip Code:88008-9449
Mailing Address - Country:US
Mailing Address - Phone:575-589-3200
Mailing Address - Fax:575-589-3201
Practice Address - Street 1:1300 COUNTRY CLUB RD
Practice Address - Street 2:SUITE B
Practice Address - City:SANTA TERESA
Practice Address - State:NM
Practice Address - Zip Code:88008-9449
Practice Address - Country:US
Practice Address - Phone:575-589-3200
Practice Address - Fax:575-589-3201
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:RELIANT PROSTHETICS SOUTHWEST, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-06-17
Last Update Date:2011-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier