Provider Demographics
NPI:1265153670
Name:FAMILY PROSTHETIC & MEDICAL SUPPLY LLC
Entity type:Organization
Organization Name:FAMILY PROSTHETIC & MEDICAL SUPPLY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ PROSTHETIST
Authorized Official - Prefix:
Authorized Official - First Name:SCOTTY
Authorized Official - Middle Name:DEWAYNE
Authorized Official - Last Name:SAMS
Authorized Official - Suffix:
Authorized Official - Credentials:BOCP
Authorized Official - Phone:256-393-5183
Mailing Address - Street 1:111 BIG VALLEY DR STE A&B
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:AL
Mailing Address - Zip Code:36250-7004
Mailing Address - Country:US
Mailing Address - Phone:256-403-6344
Mailing Address - Fax:256-403-2459
Practice Address - Street 1:111 BIG VALLEY DR STE A&B
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:AL
Practice Address - Zip Code:36250-7004
Practice Address - Country:US
Practice Address - Phone:256-403-6344
Practice Address - Fax:256-403-2459
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-09-06
Last Update Date:2022-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetistGroup - Single Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Single Specialty