MEDICARE: ADVANCED ORTHOTICS AND PROSTHETICS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	335E00000X	Prosthetic/Orthotic Supplier

General Provider Information

NPI Number	:	1174527162
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ADVANCED ORTHOTICS AND PROSTHETICS

Provider Business Mailing Address
First Line	:	PO BOX 4331
Second Line	:
City	:	JOPLIN
State	:	MO
Zip	:	64803-4331
Country	:	US
Telephone Number	:	417-627-0999
Fax Number	:	417-627-0938

Provider Business Practice Location Address
First Line	:	215 S 2ND ST
Second Line	:	STE C
City	:	BRANSON
State	:	MO
Zip	:	65616-2860
Country	:	US
Telephone Number	:	417-239-2999
Fax Number	:	417-239-2938

Authorized Official
Title or Position	:	OWNER/PRACTITIONER
Name	:	MR. FRANK W IKERD
Credential	:	CPO
Telephone Number	:	417-239-2999

Provider Enumeration Date	:	06/08/2005
Last Update Date	:	08/22/2020

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