Healthcare Provider Details

I. General information

NPI: 1669885836
Provider Name (Legal Business Name): UNITED CARE PROSTHETICS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/05/2014
Last Update Date: 08/19/2024
Certification Date: 08/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

199 CHARMANT PL SUITE 4
RIDGELAND MS
39157-4358
US

IV. Provider business mailing address

199 CHARMANT PL SUITE 4
RIDGELAND MS
39157-4358
US

V. Phone/Fax

Practice location:
  • Phone: 601-856-8360
  • Fax: 601-856-8827
Mailing address:
  • Phone: 601-856-8360
  • Fax: 601-856-8827

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License NumberC26406
License Number StateMS
# 2
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: MR. DOUGLAS SANTRELL BANKS
Title or Position: PROSTHETIST/OWNER
Credential:
Phone: 601-856-8360