Provider Demographics
NPI:1881685535
Name:KESSLER-HEASLEY ARTIFICIAL LIMB CO
Entity Type:Organization
Organization Name:KESSLER-HEASLEY ARTIFICIAL LIMB CO
Other - Org Name:KESSLER-HEASLEY ARTIFICIAL LIMB CO
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ANGIE
Authorized Official - Middle Name:JON
Authorized Official - Last Name:MUGGENBURG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:417-889-3222
Mailing Address - Street 1:3250 S DELAWARE AVE
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65804-6486
Mailing Address - Country:US
Mailing Address - Phone:417-889-3222
Mailing Address - Fax:417-889-3223
Practice Address - Street 1:3250 S DELAWARE AVE
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65804-6486
Practice Address - Country:US
Practice Address - Phone:417-889-3222
Practice Address - Fax:417-889-3223
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-02
Last Update Date:2022-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO31417OtherBLUE CROSS BLUE SHIELD ID
MO620744805Medicaid
MO31417OtherBLUE CROSS BLUE SHIELD ID