Provider Demographics
NPI:1578541579
Name:ARTIFICIAL LIMB SPECIALISTS LLC
Entity Type:Organization
Organization Name:ARTIFICIAL LIMB SPECIALISTS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:PACK
Authorized Official - Suffix:
Authorized Official - Credentials:CP
Authorized Official - Phone:602-745-2080
Mailing Address - Street 1:7600 N 15TH ST
Mailing Address - Street 2:STE 105
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85020-4330
Mailing Address - Country:US
Mailing Address - Phone:602-745-2080
Mailing Address - Fax:602-745-2074
Practice Address - Street 1:7600 N 15TH ST
Practice Address - Street 2:SUITE 105
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85020-4330
Practice Address - Country:US
Practice Address - Phone:602-745-2080
Practice Address - Fax:602-745-2074
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-09
Last Update Date:2020-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
1286660001Medicare NSC