Healthcare Provider Details

I. General information

NPI: 1043379365
Provider Name (Legal Business Name): LIMB SALVAGE INTERNATIONAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/06/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 PLAZA SOUTH ST PMB 140
TAHLEQUAH OK
74464-4750
US

IV. Provider business mailing address

217 N MUSKOGEE AVE
TAHLEQUAH OK
74464-2725
US

V. Phone/Fax

Practice location:
  • Phone: 918-458-9888
  • Fax: 918-458-9977
Mailing address:
  • Phone: 918-456-3222
  • Fax: 918-456-3196

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number201
License Number StateOK
# 2
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number202
License Number StateOK

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
IdentifierDA7676
Identifier TypeOTHER
Identifier StateOK
Identifier IssuerRR MEDICARE GROUP #
# 2
IdentifierP00086097
Identifier TypeOTHER
Identifier StateKS
Identifier IssuerRR MEDICARE # DR J BURK
# 3
IdentifierP0071200
Identifier TypeOTHER
Identifier StateOK
Identifier IssuerDR R BURK INDIV RR MEDICA

VIII. Authorized Official

Name: DR. JULIET C BURK
Title or Position: OWNER
Credential: DPM
Phone: 918-456-3222