=====================================================
General NPI Number Information
=====================================================
NPI Number | 1265428122
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BOSTON ARTIFICIAL LIMB COMPANY, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/26/2005
-----------------------------------------------------
Last Update Date | 10/22/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 44 MIDDLESEX TPKE
-----------------------------------------------------
City | BURLINGTON
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 01803-4912
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 781-272-3132
-----------------------------------------------------
Fax | 781-272-5605
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 44 MIDDLESEX TPKE
-----------------------------------------------------
City | BURLINGTON
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 01803-4912
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 781-272-3132
-----------------------------------------------------
Fax | 781-272-5605
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | MR. WILLIAM L ROGERS
-----------------------------------------------------
Credential | C.P.
-----------------------------------------------------
Telephone | 781-272-3132
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 335E00000X
-----------------------------------------------------
Taxonomy Name | Prosthetic/Orthotic Supplier
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------