Provider Demographics
NPI:1790026201
Name:PROSTHETIC DESIGN & RESEARCH LLC
Entity type:Organization
Organization Name:PROSTHETIC DESIGN & RESEARCH LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:BEARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:405-900-4935
Mailing Address - Street 1:14201 BRUCE B DOWNS BLVD STE 4
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33613-3906
Mailing Address - Country:US
Mailing Address - Phone:813-971-1100
Mailing Address - Fax:813-971-9300
Practice Address - Street 1:14201 BRUCE B DOWNS BLVD STE 4
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33613-3906
Practice Address - Country:US
Practice Address - Phone:813-971-1100
Practice Address - Fax:813-971-9300
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-07
Last Update Date:2024-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier