Provider Demographics
NPI: | 1942621016 |
---|---|
Name: | UNITED PROSTHETICS & ORTHOTICS, LLC |
Entity Type: | Organization |
Organization Name: | UNITED PROSTHETICS & ORTHOTICS, LLC |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | MANAGER |
Authorized Official - Prefix: | |
Authorized Official - First Name: | REGINALD |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | MAYS |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 205-276-6582 |
Mailing Address - Street 1: | 709 B MEMORIAL DR. |
Mailing Address - Street 2: | |
Mailing Address - City: | BESSEMER |
Mailing Address - State: | AL |
Mailing Address - Zip Code: | 35022 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 205-276-6582 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 709 MEMORIAL DR |
Practice Address - Street 2: | B |
Practice Address - City: | BESSEMER |
Practice Address - State: | AL |
Practice Address - Zip Code: | 35022-6029 |
Practice Address - Country: | US |
Practice Address - Phone: | 205-276-6582 |
Practice Address - Fax: | |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2013-12-17 |
Last Update Date: | 2014-10-08 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 335E00000X | Suppliers | Prosthetic/Orthotic Supplier | Group - Multi-Specialty | |
No | 222Z00000X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Orthotist | Group - Multi-Specialty | |
No | 224L00000X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Pedorthist | Group - Multi-Specialty | |
No | 224P00000X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Prosthetist | Group - Multi-Specialty | |
No | 224Z00000X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapy Assistant | Group - Multi-Specialty | |
No | 225000000X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Orthotic Fitter | Group - Multi-Specialty | |
No | 225100000X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | Group - Multi-Specialty | |
No | 225200000X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapy Assistant | Group - Multi-Specialty | |
No | 225X00000X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | Group - Multi-Specialty |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
AL | 7201550001 | Medicare NSC |