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General NPI Number Information
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NPI Number | 1578917654
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Entity Type | Organization
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Legal Business Name | INNOVATIVE PROSTHETICS INC
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Dates
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Enumeration Date | 04/14/2016
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Last Update Date | 04/14/2016
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Provider Practice Location Address
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Address Line | 935 S KIMBALL AVE STE 170
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City | SOUTHLAKE
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State | TX
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Zip | 76092-9032
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Country | US
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Telephone | 866-923-0515
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Fax | 866-981-5223
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Provider Business Mailing Address
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Address Line | 935 S KIMBALL AVE STE 170
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City | SOUTHLAKE
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State | TX
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Zip | 76092-9032
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Country | US
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Telephone | 866-923-0515
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Fax | 866-981-5223
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Authorized Official
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Title or Position | OWNER/BUSINESS MANAGER
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Name | MRS. LISA MARIE WILLIAMS
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Credential |
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Telephone | 866-923-0515
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number |
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License Number State | TX
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