=====================================================
General NPI Number Information
=====================================================
NPI Number | 1194011692
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PLAN B CONSULTING LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/22/2011
-----------------------------------------------------
Last Update Date | 06/22/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 15553 W GELDING DR
-----------------------------------------------------
City | SURPRISE
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85379-6258
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 702-325-7716
-----------------------------------------------------
Fax | 623-218-6658
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 15553 W GELDING DR
-----------------------------------------------------
City | SURPRISE
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85379-6258
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 702-325-7716
-----------------------------------------------------
Fax | 623-218-6658
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MANAGING MEMBER
-----------------------------------------------------
Name | JACQUELINE JUNE WEIDE
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 702-325-7716
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 335E00000X
-----------------------------------------------------
Taxonomy Name | Prosthetic/Orthotic Supplier
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------