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General NPI Number Information
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NPI Number | 1396756987
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Entity Type | Organization
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Legal Business Name | FOUR CORNERS ARTIFICIAL LIMB & BRACE
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Dates
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Enumeration Date | 08/10/2006
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Last Update Date | 02/16/2024
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Provider Practice Location Address
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Address Line | 653 W BROADWAY
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City | FARMINGTON
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State | NM
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Zip | 87401-5910
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Country | US
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Telephone | 505-326-6305
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Fax | 505-326-6325
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Provider Business Mailing Address
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Address Line | 653 W BROADWAY
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City | FARMINGTON
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State | NM
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Zip | 87401-5910
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Country | US
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Telephone | 505-326-6305
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Fax |
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Authorized Official
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Title or Position | OWNER, PRESIDENT
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Name | MR. JUSTIN HOWARD MARSHALL
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Credential |
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Telephone | 505-326-6305
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 335E00000X
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Taxonomy Name | Prosthetic/Orthotic Supplier
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number |
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License Number State |
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