Healthcare Provider Details

I. General information

NPI: 1952767956
Provider Name (Legal Business Name): OTTO BOCK ORTHOPEDIC SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/06/2016
Last Update Date: 03/10/2026
Certification Date: 03/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4022 E BROADWAY RD STE 113
PHOENIX AZ
85040-8825
US

IV. Provider business mailing address

PO BOX 734949
DALLAS TX
75373-4949
US

V. Phone/Fax

Practice location:
  • Phone: 800-736-8276
  • Fax:
Mailing address:
  • Phone: 800-736-8276
  • Fax: 866-642-2302

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License NumberC001316
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number State

VIII. Authorized Official

Name: KIMBERLY LEWIS
Title or Position: EVP OF LICENSURE
Credential:
Phone: 512-806-2756