Provider Demographics
NPI:1265616643
Name:ARTISAN PROSTHETICS LLC
Entity type:Organization
Organization Name:ARTISAN PROSTHETICS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:MITCHELL
Authorized Official - Last Name:MCNAMEE
Authorized Official - Suffix:
Authorized Official - Credentials:CP
Authorized Official - Phone:602-667-7827
Mailing Address - Street 1:1131 E HIGHLAND AVE
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85014-3639
Mailing Address - Country:US
Mailing Address - Phone:602-667-7827
Mailing Address - Fax:602-667-7826
Practice Address - Street 1:4501 N 32ND ST
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85018-3339
Practice Address - Country:US
Practice Address - Phone:602-667-7827
Practice Address - Fax:602-667-7826
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-20
Last Update Date:2023-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ1265616643Medicaid