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General NPI Number Information
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NPI Number | 1578541579
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Entity Type | Organization
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Legal Business Name | ARTIFICIAL LIMB SPECIALISTS LLC
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Dates
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Enumeration Date | 01/09/2006
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Last Update Date | 07/29/2020
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Provider Practice Location Address
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Address Line | 7600 N 15TH ST SUITE 105
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City | PHOENIX
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State | AZ
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Zip | 85020-4330
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Country | US
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Telephone | 602-745-2080
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Fax | 602-745-2074
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Provider Business Mailing Address
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Address Line | 7600 N 15TH ST STE 105
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City | PHOENIX
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State | AZ
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Zip | 85020-4330
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Country | US
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Telephone | 602-745-2080
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Fax | 602-745-2074
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Authorized Official
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Title or Position | PRESIDENT
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Name | MICHAEL ALAN PACK
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Credential | C.P.
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Telephone | 602-745-2080
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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 | AZ
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