MEDICARE: SAMUEL WEISBERG CPO

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	1744P3200X	Prosthetics Case Management

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1730181959
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SAMUEL WEISBERG CPO

Provider Business Mailing Address
First Line	:	1018 COAL AVE SE
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87106-5206
Country	:	US
Telephone Number	:	505-248-0303
Fax Number	:	505-248-1611

Provider Business Practice Location Address
First Line	:	1018 COAL AVE SE
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87106-5206
Country	:	US
Telephone Number	:	505-248-0303
Fax Number	:	505-248-1611

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/01/2005
Last Update Date	:	01/24/2008

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