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General NPI Number Information
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NPI Number | 1912173907
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Entity Type | Organization
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Legal Business Name | LIMB SALVAGE INTERNATIONAL
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Dates
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Enumeration Date | 04/30/2008
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Last Update Date | 04/30/2008
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Provider Practice Location Address
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Address Line | 3413 N 14TH ST
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City | PONCA CITY
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State | OK
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Zip | 74601-1039
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Country | US
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Telephone | 580-718-0002
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Fax |
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Provider Business Mailing Address
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Address Line | 1 PLAZA SOUTH ST PMB 140
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City | TAHLEQUAH
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State | OK
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Zip | 74464-4750
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Country | US
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Telephone | 918-458-9888
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Fax |
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Authorized Official
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Title or Position | COO
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Name | DR. JULIET C. BURK
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Credential | D.P.M.
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Telephone | 918-458-9888
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number | 23029
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License Number State | OK
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