Provider Demographics
NPI:1952154833
Name:GATES PROSTHETICS & MOBILITY CLINIC CO
Entity Type:Organization
Organization Name:GATES PROSTHETICS & MOBILITY CLINIC CO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TERRAN
Authorized Official - Middle Name:ELIZABETH
Authorized Official - Last Name:GATES
Authorized Official - Suffix:
Authorized Official - Credentials:CPO
Authorized Official - Phone:870-307-2174
Mailing Address - Street 1:706 S WALTON BLVD STE 6
Mailing Address - Street 2:
Mailing Address - City:BENTONVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72712-5751
Mailing Address - Country:US
Mailing Address - Phone:479-418-2297
Mailing Address - Fax:
Practice Address - Street 1:706 S WALTON BLVD STE 6
Practice Address - Street 2:
Practice Address - City:BENTONVILLE
Practice Address - State:AR
Practice Address - Zip Code:72712-5751
Practice Address - Country:US
Practice Address - Phone:479-418-2297
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GATES PROSTHETICS & MOBILITY CLINIC CO
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-04-09
Last Update Date:2024-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier