Provider Demographics
NPI:1669885836
Name:UNITED CARE PROSTHETICS LLC
Entity type:Organization
Organization Name:UNITED CARE PROSTHETICS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROSTHETIST/OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:SANTRELL
Authorized Official - Last Name:BANKS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:601-856-8360
Mailing Address - Street 1:199 CHARMANT PL
Mailing Address - Street 2:SUITE 4
Mailing Address - City:RIDGELAND
Mailing Address - State:MS
Mailing Address - Zip Code:39157-4358
Mailing Address - Country:US
Mailing Address - Phone:601-856-8360
Mailing Address - Fax:601-856-8827
Practice Address - Street 1:199 CHARMANT PL
Practice Address - Street 2:SUITE 4
Practice Address - City:RIDGELAND
Practice Address - State:MS
Practice Address - Zip Code:39157-4358
Practice Address - Country:US
Practice Address - Phone:601-856-8360
Practice Address - Fax:601-856-8827
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-05
Last Update Date:2024-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSC26406335E00000X
332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No335E00000XSuppliersProsthetic/Orthotic Supplier