MEDICARE: AMPUTEE CLINIC, INC.

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	261QP2000X	Physical Therapy Clinic/Center
2	335E00000X	Prosthetic/Orthotic Supplier

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	81750	OTHER	MI	NORTHWOOD (BC/BS MI DME)
3	204925600	OTHER	TN	TVA
4	8150	OTHER	MI	NORTHWOOD
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
6	52895744 001	OTHER	GA	GEORGIA HEALTH PARTNERSHI
7	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
8	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
9	004016999	OTHER	TN	BC/BS OF TN
10	13125	OTHER	TN	PHP, CARITEN, PHP TENNCAR
11	4016999	OTHER	TN	BC/BS TN

General Provider Information

NPI Number	:	1295730216
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AMPUTEE CLINIC, INC.

Provider Business Mailing Address
First Line	:	44 BARKLEY CIR
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33907-7530
Country	:	US
Telephone Number	:	239-437-4010
Fax Number	:	239-437-4097

Provider Business Practice Location Address
First Line	:	44 BARKLEY CIR
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33907-7530
Country	:	US
Telephone Number	:	239-437-4010
Fax Number	:	239-437-4097

Authorized Official
Title or Position	:	OWNER
Name	:	MR. AVRAHAM R BENHAIM
Credential	:
Telephone Number	:	239-437-4010

Provider Enumeration Date	:	06/16/2005
Last Update Date	:	12/11/2025

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