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General NPI Number Information
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NPI Number | 1417509910
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Entity Type | Organization
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Legal Business Name | PROFESSIONAL ORTHOTIC & PROSTHETIC SERVICES, LLC
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Dates
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Enumeration Date | 07/15/2019
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Last Update Date | 11/27/2023
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Provider Practice Location Address
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Address Line | 410 GRANT AVE
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City | CLAY CENTER
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State | KS
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Zip | 67432-2942
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Country | US
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Telephone | 785-375-7458
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Fax | 785-320-2321
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Provider Business Mailing Address
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Address Line | 919 WESTPORT PL
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City | MANHATTAN
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State | KS
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Zip | 66502-2913
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Country | US
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Telephone | 785-375-7458
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Fax | 785-320-2321
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Authorized Official
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Title or Position | OWNER
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Name | BRANDON LEE SMITH
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Credential | CP, BOCO, MSOP
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Telephone | 785-375-7458
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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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