Provider Demographics
NPI:1972610897
Name:MISSISSIPPI ARTIFICIAL LIMB AND BRACE LLC
Entity Type:Organization
Organization Name:MISSISSIPPI ARTIFICIAL LIMB AND BRACE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:RICKY
Authorized Official - Middle Name:
Authorized Official - Last Name:PARTAIN
Authorized Official - Suffix:
Authorized Official - Credentials:CPO
Authorized Official - Phone:256-549-0064
Mailing Address - Street 1:305 S 4TH ST
Mailing Address - Street 2:
Mailing Address - City:GADSDEN
Mailing Address - State:AL
Mailing Address - Zip Code:35901-5212
Mailing Address - Country:US
Mailing Address - Phone:256-549-0064
Mailing Address - Fax:256-549-0002
Practice Address - Street 1:6086 HWY 49 SOUTH
Practice Address - Street 2:
Practice Address - City:HATTIESBURG
Practice Address - State:MS
Practice Address - Zip Code:39401
Practice Address - Country:US
Practice Address - Phone:601-579-7430
Practice Address - Fax:601-579-8656
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL41335E00000X
AL42335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered335E00000XSuppliersProsthetic/Orthotic Supplier