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General NPI Number Information
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NPI Number | 1528759545
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Entity Type | Organization
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Legal Business Name | GATES PROSTHETICS & MOBILITY CLINIC CO
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Dates
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Enumeration Date | 05/19/2023
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Last Update Date | 09/14/2023
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Provider Practice Location Address
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Address Line | 1325 N MAIN ST
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City | HARRISON
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State | AR
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Zip | 72601-2212
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Country | US
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Telephone | 870-307-2174
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Fax |
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Provider Business Mailing Address
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Address Line | 11766 VALLEYVIEW LN
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City | BENTONVILLE
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State | AR
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Zip | 72712-9330
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Country | US
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Telephone | 870-307-2174
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | TERRAN GATES
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Credential | CPO
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Telephone | 479-418-2297
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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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