Provider Demographics
NPI:1720075807
Name:ABC ORTHOTICS AND PROSTHETICS
Entity Type:Organization
Organization Name:ABC ORTHOTICS AND PROSTHETICS
Other - Org Name:ABC ORTHOTICS AND PROSTHETICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:NORMAN
Authorized Official - Middle Name:VINCENT
Authorized Official - Last Name:YANKUS
Authorized Official - Suffix:
Authorized Official - Credentials:CLO
Authorized Official - Phone:251-316-3160
Mailing Address - Street 1:805 DOWNTOWNER LOOP W
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36609-5403
Mailing Address - Country:US
Mailing Address - Phone:251-316-3160
Mailing Address - Fax:251-316-3950
Practice Address - Street 1:805 DOWNTOWNER LOOP W
Practice Address - Street 2:
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36609-5403
Practice Address - Country:US
Practice Address - Phone:251-316-3160
Practice Address - Fax:251-316-3950
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-04
Last Update Date:2023-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL2005008028335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL5480380001Medicare NSC