Provider Demographics
NPI:1760768196
Name:AMERICAN LIMB & ORTHOPEDIC COMPANY OF VALPARAISO
Entity Type:Organization
Organization Name:AMERICAN LIMB & ORTHOPEDIC COMPANY OF VALPARAISO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:DAGNY
Authorized Official - Middle Name:
Authorized Official - Last Name:LAUR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:219-531-7479
Mailing Address - Street 1:201 E. MORTHLAND DR
Mailing Address - Street 2:SUITE 2
Mailing Address - City:VALPARAISO
Mailing Address - State:IN
Mailing Address - Zip Code:46383
Mailing Address - Country:US
Mailing Address - Phone:219-531-7479
Mailing Address - Fax:
Practice Address - Street 1:3777 N. FRONTAGE RD
Practice Address - Street 2:SUITE 100
Practice Address - City:MICHIGAN CITY
Practice Address - State:IN
Practice Address - Zip Code:46360
Practice Address - Country:US
Practice Address - Phone:219-531-7479
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-31
Last Update Date:2011-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier