Provider Demographics
NPI:1780681288
Name:AMERICAN LIMB & ORTHOPEDIC CO
Entity Type:Organization
Organization Name:AMERICAN LIMB & ORTHOPEDIC CO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CORP. SECRETARY
Authorized Official - Prefix:MS
Authorized Official - First Name:DAGMAR
Authorized Official - Middle Name:
Authorized Official - Last Name:GUNDLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:574-287-3767
Mailing Address - Street 1:2930 MCKINLEY AVE
Mailing Address - Street 2:
Mailing Address - City:SOUTH BEND
Mailing Address - State:IN
Mailing Address - Zip Code:46615-2739
Mailing Address - Country:US
Mailing Address - Phone:574-287-3767
Mailing Address - Fax:574-289-0882
Practice Address - Street 1:2930 MCKINLEY AVE
Practice Address - Street 2:
Practice Address - City:SOUTH BEND
Practice Address - State:IN
Practice Address - Zip Code:46615-2739
Practice Address - Country:US
Practice Address - Phone:574-287-3767
Practice Address - Fax:574-287-3767
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-30
Last Update Date:2011-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100278250AMedicaid
IN100278250AMedicaid