Healthcare Provider Details

I. General information

NPI: 1831546381
Provider Name (Legal Business Name): EXTENSIONU LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/14/2016
Last Update Date: 05/14/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5168 OSCEOLA DR
DAYTON OH
45417-8215
US

IV. Provider business mailing address

5168 OSCEOLA DR
DAYTON OH
45417-8215
US

V. Phone/Fax

Practice location:
  • Phone: 937-867-8155
  • Fax: 513-351-2650
Mailing address:
  • Phone:
  • Fax: 513-351-2650

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number State

VIII. Authorized Official

Name: MS. ANGELA WADE
Title or Position: OWNER
Credential:
Phone: 937-867-8155