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General NPI Number Information
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NPI Number | 1881794675
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Entity Type | Organization
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Legal Business Name | COBB PROSTHETICS, LLC
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Dates
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Enumeration Date | 09/22/2006
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Last Update Date | 12/14/2007
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Provider Practice Location Address
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Address Line | 833 WEBER RD.
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City | FARMINGTON
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State | MO
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Zip | 63640
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Country | US
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Telephone | 573-760-0520
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Fax | 573-760-0530
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Provider Business Mailing Address
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Address Line | 833 WEBER RD.
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City | FARMINGTON
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State | MO
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Zip | 63640
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Country | US
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Telephone | 573-760-0520
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Fax | 573-760-0530
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Authorized Official
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Title or Position | OWNER/CERTIFIED PROSTHETIST
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Name | MR. MATTHEW D. COBB
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Credential | CP
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Telephone | 573-760-0520
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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 | CP2633
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License Number State | MO
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