Healthcare Provider Details

I. General information

NPI: 1437339439
Provider Name (Legal Business Name): MOBILE LIMB & BRACE, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/07/2007
Last Update Date: 11/07/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2041 KLONDIKE RD
WEST LAFAYETTE IN
47906-5122
US

IV. Provider business mailing address

2041 KLONDIKE RD
WEST LAFAYETTE IN
47906-5122
US

V. Phone/Fax

Practice location:
  • Phone: 765-463-4100
  • Fax: 765-463-4112
Mailing address:
  • Phone: 765-463-4100
  • Fax: 765-463-4112

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: CRAIG RICHARD DECAMP
Title or Position: OWNER
Credential: C.O.
Phone: 765-463-4100