Provider Demographics
NPI:1023345220
Name:LIMBCARE PROSTHETICS & ORTHOTICS OF GEORGIA INC
Entity type:Organization
Organization Name:LIMBCARE PROSTHETICS & ORTHOTICS OF GEORGIA INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:PATRICK
Authorized Official - Last Name:RODMAN
Authorized Official - Suffix:SR
Authorized Official - Credentials:CPO
Authorized Official - Phone:229-430-9778
Mailing Address - Street 1:915 GREER ST
Mailing Address - Street 2:UNIT A
Mailing Address - City:CORDELE
Mailing Address - State:GA
Mailing Address - Zip Code:31015-2090
Mailing Address - Country:US
Mailing Address - Phone:229-430-9778
Mailing Address - Fax:229-430-1347
Practice Address - Street 1:915 GREER ST
Practice Address - Street 2:UNIT A
Practice Address - City:CORDELE
Practice Address - State:GA
Practice Address - Zip Code:31015-2090
Practice Address - Country:US
Practice Address - Phone:229-430-9778
Practice Address - Fax:229-430-1347
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-09
Last Update Date:2010-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA6128060004Medicare NSC