Provider Demographics
NPI:1609053669
Name:CENTER FOR PROSTHETICS INC
Entity Type:Organization
Organization Name:CENTER FOR PROSTHETICS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:CAROLE
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:PERETTI
Authorized Official - Suffix:
Authorized Official - Credentials:CO BADO
Authorized Official - Phone:801-364-0083
Mailing Address - Street 1:148 S 500 E
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84102-1907
Mailing Address - Country:US
Mailing Address - Phone:801-364-0083
Mailing Address - Fax:801-364-6480
Practice Address - Street 1:148 S 500 E
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84102-1907
Practice Address - Country:US
Practice Address - Phone:801-364-0083
Practice Address - Fax:801-364-6480
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-22
Last Update Date:2008-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT310725990007Medicaid
UT310725990007Medicaid