Healthcare Provider Details

I. General information

NPI: 1982288692
Provider Name (Legal Business Name): ADVANCED LIMB SALVAGE CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/09/2021
Last Update Date: 04/28/2022
Certification Date: 04/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3040 MARKET ST
CAMP HILL PA
17011-4539
US

IV. Provider business mailing address

3040 MARKET ST
CAMP HILL PA
17011-4539
US

V. Phone/Fax

Practice location:
  • Phone: 717-727-0480
  • Fax: 717-727-0479
Mailing address:
  • Phone: 717-727-0480
  • Fax: 717-327-4613

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License Number
License Number State

VIII. Authorized Official

Name: ANGELA BROOKS
Title or Position: PRACTICE ADMINISTRATOR
Credential:
Phone: 717-727-0480