=====================================================
General NPI Number Information
=====================================================
NPI Number | 1558485987
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | JOSHUA C ALLISON
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/19/2007
-----------------------------------------------------
Last Update Date | 12/04/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4225 S STATE ROUTE 159 STE 1
-----------------------------------------------------
City | GLEN CARBON
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 62034-3231
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 618-288-9297
-----------------------------------------------------
Fax | 618-288-1260
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4225 S STATE ROUTE 159 STE 1
-----------------------------------------------------
City | GLEN CARBON
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 62034-3231
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 618-288-9297
-----------------------------------------------------
Fax | 618-288-1260
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MANAGER
-----------------------------------------------------
Name | WANDA T MILLER
-----------------------------------------------------
Credential | CPC
-----------------------------------------------------
Telephone | 615-217-9821
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 335E00000X
-----------------------------------------------------
Taxonomy Name | Prosthetic/Orthotic Supplier
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------