Provider Demographics
NPI:1891853222
Name:LIMB SALVAGE INTERNATIONAL
Entity Type:Organization
Organization Name:LIMB SALVAGE INTERNATIONAL
Other - Org Name:LSI FOOT CLINIC #1
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:REED
Authorized Official - Middle Name:K
Authorized Official - Last Name:BURK
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:918-458-9888
Mailing Address - Street 1:1 PLAZA SOUTH ST PMB 140
Mailing Address - Street 2:
Mailing Address - City:TAHLEQUAH
Mailing Address - State:OK
Mailing Address - Zip Code:74464-4750
Mailing Address - Country:US
Mailing Address - Phone:918-458-9888
Mailing Address - Fax:918-458-9977
Practice Address - Street 1:3413 N 14TH ST
Practice Address - Street 2:
Practice Address - City:PONCA CITY
Practice Address - State:OK
Practice Address - Zip Code:74601-1039
Practice Address - Country:US
Practice Address - Phone:580-718-0002
Practice Address - Fax:580-718-0003
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK201332B00000X
OK202332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK=========001OtherBC #
OK5329300001Medicare ID - Type UnspecifiedINDIV PROVIDER # MEDICARE
OKU63067Medicare UPIN
OK=========001OtherBC #