Provider Demographics
NPI:1841795341
Name:LEDBETTER PROSTHETICS AND ORTHOTICS, INC.
Entity Type:Organization
Organization Name:LEDBETTER PROSTHETICS AND ORTHOTICS, INC.
Other - Org Name:NATIONAL DME SUPPLY, INC.
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BRANDON
Authorized Official - Middle Name:E
Authorized Official - Last Name:LEDBETTER
Authorized Official - Suffix:
Authorized Official - Credentials:BOCPO/LP/LOF
Authorized Official - Phone:334-792-1527
Mailing Address - Street 1:186 BELMONT DR.
Mailing Address - Street 2:
Mailing Address - City:DOTHAN
Mailing Address - State:AL
Mailing Address - Zip Code:36305-6501
Mailing Address - Country:US
Mailing Address - Phone:334-792-1527
Mailing Address - Fax:334-792-6117
Practice Address - Street 1:186 BELMONT DR.
Practice Address - Street 2:
Practice Address - City:DOTHAN
Practice Address - State:AL
Practice Address - Zip Code:36305-6501
Practice Address - Country:US
Practice Address - Phone:334-792-1527
Practice Address - Fax:334-792-6117
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-27
Last Update Date:2023-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL838335E00000X
335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL249114Medicaid