Provider Demographics
NPI:1508586694
Name:CUSTOM ARTIFICIAL LIMB AND BRACE, INC.
Entity Type:Organization
Organization Name:CUSTOM ARTIFICIAL LIMB AND BRACE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:BOBBY
Authorized Official - Middle Name:
Authorized Official - Last Name:COLES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:724-654-3991
Mailing Address - Street 1:491 E BRUCETON RD
Mailing Address - Street 2:
Mailing Address - City:PLEASANT HILLS
Mailing Address - State:PA
Mailing Address - Zip Code:15236-5525
Mailing Address - Country:US
Mailing Address - Phone:724-654-3991
Mailing Address - Fax:
Practice Address - Street 1:491 E BRUCETON RD
Practice Address - Street 2:
Practice Address - City:PLEASANT HILLS
Practice Address - State:PA
Practice Address - Zip Code:15236-5525
Practice Address - Country:US
Practice Address - Phone:724-654-3991
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CUSTOM ARTIFICIAL LIMB AND BRACE, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-08-30
Last Update Date:2022-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier