Provider Demographics
NPI:1437339439
Name:MOBILE LIMB & BRACE, INC
Entity Type:Organization
Organization Name:MOBILE LIMB & BRACE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CRAIG
Authorized Official - Middle Name:RICHARD
Authorized Official - Last Name:DECAMP
Authorized Official - Suffix:
Authorized Official - Credentials:CO
Authorized Official - Phone:765-463-4100
Mailing Address - Street 1:2041 KLONDIKE RD
Mailing Address - Street 2:
Mailing Address - City:WEST LAFAYETTE
Mailing Address - State:IN
Mailing Address - Zip Code:47906-5122
Mailing Address - Country:US
Mailing Address - Phone:765-463-4100
Mailing Address - Fax:765-463-4112
Practice Address - Street 1:2041 KLONDIKE RD
Practice Address - Street 2:
Practice Address - City:WEST LAFAYETTE
Practice Address - State:IN
Practice Address - Zip Code:47906-5122
Practice Address - Country:US
Practice Address - Phone:765-463-4100
Practice Address - Fax:765-463-4112
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-07
Last Update Date:2007-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN4258180001Medicare NSC