Provider Demographics
NPI:1285934869
Name:PA ARTIFICIAL LIMB & BRACE CO., INC..
Entity type:Organization
Organization Name:PA ARTIFICIAL LIMB & BRACE CO., INC..
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:C
Authorized Official - Last Name:CUMMINGS
Authorized Official - Suffix:
Authorized Official - Credentials:CPO
Authorized Official - Phone:724-588-6860
Mailing Address - Street 1:224 W 26TH ST
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16508-1806
Mailing Address - Country:US
Mailing Address - Phone:814-868-5231
Mailing Address - Fax:814-868-5232
Practice Address - Street 1:111 N MAIN ST
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:PA
Practice Address - Zip Code:16125-1705
Practice Address - Country:US
Practice Address - Phone:724-588-6860
Practice Address - Fax:814-868-5232
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-28
Last Update Date:2016-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0005681300001Medicaid