Provider Demographics
NPI:1962022822
Name:INNOVATIVE PROTHESTICS AND RESEARCH, LLC
Entity Type:Organization
Organization Name:INNOVATIVE PROTHESTICS AND RESEARCH, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LINDSAY
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:LA FUENTE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:405-740-3129
Mailing Address - Street 1:15224 SE 73RD ST
Mailing Address - Street 2:
Mailing Address - City:CHOCTAW
Mailing Address - State:OK
Mailing Address - Zip Code:73020-5009
Mailing Address - Country:US
Mailing Address - Phone:405-740-3129
Mailing Address - Fax:
Practice Address - Street 1:229 NW 9TH ST STE 104
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73102-2619
Practice Address - Country:US
Practice Address - Phone:405-740-3129
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-04-21
Last Update Date:2020-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
No224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetistGroup - Single Specialty