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General NPI Number Information
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NPI Number | 1609052141
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Entity Type | Organization
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Legal Business Name | AFO LAB
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Dates
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Enumeration Date | 01/15/2008
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Last Update Date | 01/15/2008
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Provider Practice Location Address
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Address Line | 9185 LANDIS DR
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City | BEAUMONT
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State | TX
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Zip | 77707-1245
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Country | US
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Telephone | 409-860-3156
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 21293
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City | BEAUMONT
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State | TX
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Zip | 77720-1293
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Country | US
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Telephone | 409-860-3156
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MS. JAN HOLLEY
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Credential |
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Telephone | 409-860-3156
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332BC3200X
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Taxonomy Name | Customized Equipment (DME)
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License Number |
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License Number State |
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