Healthcare Provider Details

I. General information

NPI: 1679156699
Provider Name (Legal Business Name): 3D PROSTHETICS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/29/2021
Last Update Date: 12/19/2023
Certification Date: 12/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2011 CHESTER BLVD
RICHMOND IN
47374-1214
US

IV. Provider business mailing address

2011 CHESTER BLVD
RICHMOND IN
47374-1214
US

V. Phone/Fax

Practice location:
  • Phone: 765-488-1165
  • Fax:
Mailing address:
  • Phone: 765-488-1165
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224P00000X
TaxonomyProsthetist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number State

VIII. Authorized Official

Name: MS. LUCINDA B BUSCH
Title or Position: SR. ADMINISTRATIVE SPECIALIST
Credential: CP, LP
Phone: 765-756-5014