Provider Demographics
NPI:1538305990
Name:LIMA BRACE & LIMB, INC
Entity Type:Organization
Organization Name:LIMA BRACE & LIMB, INC
Other - Org Name:VAN WERT BRACE & LIMB
Other - Org Type:Doing Business As
Authorized Official - Title/Position:LICENSED PROSTHETIST/ORTHOTIST
Authorized Official - Prefix:MR
Authorized Official - First Name:KIRK
Authorized Official - Middle Name:
Authorized Official - Last Name:WISE
Authorized Official - Suffix:
Authorized Official - Credentials:LPO
Authorized Official - Phone:419-238-6300
Mailing Address - Street 1:120 E ERVIN RD
Mailing Address - Street 2:
Mailing Address - City:VAN WERT
Mailing Address - State:OH
Mailing Address - Zip Code:45891-2519
Mailing Address - Country:US
Mailing Address - Phone:419-238-6300
Mailing Address - Fax:419-238-9400
Practice Address - Street 1:120 E ERVIN RD
Practice Address - Street 2:
Practice Address - City:VAN WERT
Practice Address - State:OH
Practice Address - Zip Code:45891-2519
Practice Address - Country:US
Practice Address - Phone:419-238-6300
Practice Address - Fax:419-238-9400
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LIMA BRACE & LIMB, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-01-06
Last Update Date:2009-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHLPO136335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier