MEDICARE: WINN'S ORTHOTICS & PROSTHETICS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332BC3200X	Customized Equipment (DME)	CPO02652	AZ
2	1744P3200X	Prosthetics Case Management

General Provider Information

NPI Number	:	1225208481
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WINN'S ORTHOTICS & PROSTHETICS

Provider Business Mailing Address
First Line	:	1075 S IDAHO RD
Second Line	:	SUITE 101
City	:	APACHE JUNCTION
State	:	AZ
Zip	:	85219-6496
Country	:	US
Telephone Number	:	480-982-3000
Fax Number	:	480-982-3103

Provider Business Practice Location Address
First Line	:	1075 S IDAHO RD
Second Line	:	SUITE 101
City	:	APACHE JUNCTION
State	:	AZ
Zip	:	85219-6496
Country	:	US
Telephone Number	:	480-982-3000
Fax Number	:	480-982-3103

Authorized Official
Title or Position	:	OWNER
Name	:	MR. SHANNON COLE WINN
Credential	:	CPO
Telephone Number	:	480-982-3000

Provider Enumeration Date	:	03/04/2008
Last Update Date	:	03/06/2008

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