Provider Demographics
NPI:1619115284
Name:FORT SMITH ARTIFICIAL LIMB AND BRACE, INC.
Entity Type:Organization
Organization Name:FORT SMITH ARTIFICIAL LIMB AND BRACE, INC.
Other - Org Name:ARKANSAS ORTHOTICS AND PROSTHETICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:LELAND
Authorized Official - Middle Name:F
Authorized Official - Last Name:FELIX
Authorized Official - Suffix:
Authorized Official - Credentials:CPO, FAAOP
Authorized Official - Phone:501-321-4222
Mailing Address - Street 1:124 LEIGH CIR
Mailing Address - Street 2:
Mailing Address - City:HOT SPRINGS
Mailing Address - State:AR
Mailing Address - Zip Code:71901-7713
Mailing Address - Country:US
Mailing Address - Phone:501-321-4222
Mailing Address - Fax:501-321-0849
Practice Address - Street 1:218 VINEYARD ST
Practice Address - Street 2:
Practice Address - City:HOT SPRINGS
Practice Address - State:AR
Practice Address - Zip Code:71913-5229
Practice Address - Country:US
Practice Address - Phone:501-321-4222
Practice Address - Fax:501-321-0849
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-04
Last Update Date:2009-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AROPP00051335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier