Provider Demographics
NPI:1518033505
Name:LONG BEACH ARTIFICIAL LIMB CO INC
Entity Type:Organization
Organization Name:LONG BEACH ARTIFICIAL LIMB CO INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:BARRY
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:CP
Authorized Official - Phone:562-426-5531
Mailing Address - Street 1:2268 LONG BEACH BLVD
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90806-4417
Mailing Address - Country:US
Mailing Address - Phone:562-426-5531
Mailing Address - Fax:562-426-6773
Practice Address - Street 1:2268 LONG BEACH BLVD
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90806-4417
Practice Address - Country:US
Practice Address - Phone:562-426-5531
Practice Address - Fax:562-426-6773
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-28
Last Update Date:2012-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
No261QA0900XAmbulatory Health Care FacilitiesClinic/CenterAmputee
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGFB000020Medicaid
CAGFB000020Medicaid