Healthcare Provider Details

I. General information

NPI: 1912332982
Provider Name (Legal Business Name): AMPUTEE CENTER, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/10/2013
Last Update Date: 11/27/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23730 COUNTY ROAD 675
MYAKKA CITY FL
34251-9138
US

IV. Provider business mailing address

23730 COUNTY ROAD 675
MYAKKA CITY FL
34251-9138
US

V. Phone/Fax

Practice location:
  • Phone: 941-322-1840
  • Fax:
Mailing address:
  • Phone: 941-322-1840
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License NumberPRO43
License Number StateFL

VIII. Authorized Official

Name: ANNE L CLEALL
Title or Position: PRESIDENT
Credential:
Phone: 941-322-1840