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General NPI Number Information
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NPI Number | 1548545585
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Entity Type | Organization
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Legal Business Name | INNOVATIVE PROSTHETICS & ORTHOTICS OF GRAND ISLAND, LLC
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Dates
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Enumeration Date | 10/20/2011
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Last Update Date | 10/16/2014
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Provider Practice Location Address
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Address Line | 1213 ALLEN DR
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City | GRAND ISLAND
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State | NE
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Zip | 68803-3333
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Country | US
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Telephone | 308-675-1508
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Fax | 308-675-1509
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Provider Business Mailing Address
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Address Line | 1213 ALLEN DR
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City | GRAND ISLAND
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State | NE
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Zip | 68803-3333
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Country | US
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Telephone | 308-675-1508
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Fax | 308-675-1509
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Authorized Official
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Title or Position | OWNER
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Name | RAKESH SRIVASTAVA
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Credential |
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Telephone | 402-461-4931
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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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