Provider Demographics
NPI:1275514440
Name:AMPUTEE CARE CENTER,INC.
Entity Type:Organization
Organization Name:AMPUTEE CARE CENTER,INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CERTIFIED PROSTHETIST
Authorized Official - Prefix:MR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:T
Authorized Official - Last Name:DAMICO
Authorized Official - Suffix:
Authorized Official - Credentials:CP
Authorized Official - Phone:317-598-9557
Mailing Address - Street 1:9780 LANTERN RD
Mailing Address - Street 2:SUITE 140
Mailing Address - City:FISHERS
Mailing Address - State:IN
Mailing Address - Zip Code:46037-4092
Mailing Address - Country:US
Mailing Address - Phone:317-598-9557
Mailing Address - Fax:317-598-2611
Practice Address - Street 1:9780 LANTERN RD
Practice Address - Street 2:SUITE 140
Practice Address - City:FISHERS
Practice Address - State:IN
Practice Address - Zip Code:46037-4092
Practice Address - Country:US
Practice Address - Phone:317-598-9557
Practice Address - Fax:317-598-2611
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-07
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN=========OtherEIN
IN5123100001Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER