Healthcare Provider Details

I. General information

NPI: 1578541579
Provider Name (Legal Business Name): ARTIFICIAL LIMB SPECIALISTS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/09/2006
Last Update Date: 07/29/2020
Certification Date: 07/29/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7600 N 15TH ST SUITE 105
PHOENIX AZ
85020-4330
US

IV. Provider business mailing address

7600 N 15TH ST STE 105
PHOENIX AZ
85020-4330
US

V. Phone/Fax

Practice location:
  • Phone: 602-745-2080
  • Fax: 602-745-2074
Mailing address:
  • Phone: 602-745-2080
  • Fax: 602-745-2074

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number StateAZ

VIII. Authorized Official

Name: MICHAEL ALAN PACK
Title or Position: PRESIDENT
Credential: C.P.
Phone: 602-745-2080