Provider Demographics
NPI:1982839403
Name:COBB PROSTHETICS LLC
Entity Type:Organization
Organization Name:COBB PROSTHETICS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CERTIFIED PROSTHETIST
Authorized Official - Prefix:
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:
Authorized Official - Last Name:COBB
Authorized Official - Suffix:
Authorized Official - Credentials:CP
Authorized Official - Phone:573-760-0520
Mailing Address - Street 1:11229 CONCORD VILLAGE AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63123-6903
Mailing Address - Country:US
Mailing Address - Phone:314-849-5462
Mailing Address - Fax:314-849-1377
Practice Address - Street 1:11229 CONCORD VILLAGE AVE
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63123-6903
Practice Address - Country:US
Practice Address - Phone:314-849-5462
Practice Address - Fax:314-849-1377
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COBB PROSTHETICS LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-05-28
Last Update Date:2009-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOCP2633335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO5680890002Medicare NSC