Healthcare Provider Details

I. General information

NPI: 1174932875
Provider Name (Legal Business Name): DARBY ORTHOTICS AND PROSTHETICS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/06/2014
Last Update Date: 07/07/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3407 BERRYWOOD DR STE 203
COLUMBIA MO
65201-6500
US

IV. Provider business mailing address

3407 BERRYWOOD DR STE 203
COLUMBIA MO
65201-6500
US

V. Phone/Fax

Practice location:
  • Phone: 573-777-4701
  • Fax: 573-777-4702
Mailing address:
  • Phone: 573-777-4701
  • Fax: 573-777-4702

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: MICHAEL L DARBY
Title or Position: MEMBER
Credential:
Phone: 573-777-4701