Provider Demographics
NPI:1013077064
Name:PREMIER HOPE ORTHOTIC & PROSTHETIC ENTERPRISES LLC
Entity Type:Organization
Organization Name:PREMIER HOPE ORTHOTIC & PROSTHETIC ENTERPRISES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:KIM
Authorized Official - Middle Name:
Authorized Official - Last Name:LINDSLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:318-812-0119
Mailing Address - Street 1:1209 ROYAL AVENUE
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71201
Mailing Address - Country:US
Mailing Address - Phone:318-812-0119
Mailing Address - Fax:318-812-0136
Practice Address - Street 1:1209 ROYAL AVENUE
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:LA
Practice Address - Zip Code:71201
Practice Address - Country:US
Practice Address - Phone:318-812-0119
Practice Address - Fax:318-812-0136
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-11
Last Update Date:2020-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1744P3200X
335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1744P3200XOther Service ProvidersSpecialistProsthetics Case ManagementGroup - Single Specialty
No335E00000XSuppliersProsthetic/Orthotic SupplierGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA5938070001Medicare NSC