Provider Demographics
NPI:1649478256
Name:AMERICAN LIMB AND ORTHOPEDIC COMPANY OF VALPARAISO
Entity type:Organization
Organization Name:AMERICAN LIMB AND ORTHOPEDIC COMPANY OF VALPARAISO
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DAGNY
Authorized Official - Middle Name:
Authorized Official - Last Name:LAUR
Authorized Official - Suffix:
Authorized Official - Credentials:CO
Authorized Official - Phone:219-531-7479
Mailing Address - Street 1:201 E MORTHLAND DR
Mailing Address - Street 2:SUITE 2
Mailing Address - City:VALPARAISO
Mailing Address - State:IN
Mailing Address - Zip Code:46383
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:201 E MORTHLAND DR
Practice Address - Street 2:SUITE 2
Practice Address - City:VALPARAISO
Practice Address - State:IN
Practice Address - Zip Code:46383
Practice Address - Country:US
Practice Address - Phone:219-531-7479
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-05
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN5928160001Medicare NSC