Provider Demographics
NPI:1659454445
Name:ARISE PROSTHETICS LLC
Entity type:Organization
Organization Name:ARISE PROSTHETICS LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:ANDREW
Authorized Official - Last Name:WERNER
Authorized Official - Suffix:
Authorized Official - Credentials:CPO
Authorized Official - Phone:602-864-5560
Mailing Address - Street 1:1830 W COLTER ST
Mailing Address - Street 2:SUITE 101
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85015-9000
Mailing Address - Country:US
Mailing Address - Phone:602-864-5560
Mailing Address - Fax:602-864-4958
Practice Address - Street 1:1830 W COLTER ST
Practice Address - Street 2:SUITE 101
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85015-9000
Practice Address - Country:US
Practice Address - Phone:602-864-5560
Practice Address - Fax:602-864-4958
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZAZ0278780OtherBLUE CROSS BLUE SHIELD AZ
AZ545080Medicaid
AZAZ0278780OtherBLUE CROSS BLUE SHIELD AZ