MEDICARE: SAMUEL WEISBERG PROSTHETICS LLC

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

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

General Provider Information

NPI Number	:	1316125214
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SAMUEL WEISBERG PROSTHETICS LLC

Provider Business Mailing Address
First Line	:	1018 COAL AVE SE
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87106
Country	:	US
Telephone Number	:	505-248-0303
Fax Number	:	505-248-1611

Provider Business Practice Location Address
First Line	:	1018 COAL AVE SE
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87106
Country	:	US
Telephone Number	:	505-248-0303
Fax Number	:	505-248-1611

Authorized Official
Title or Position	:	PRES/OWNER/CPO
Name	:	SAMUEL WEISBERG
Credential	:	CPO
Telephone Number	:	505-248-0303

Provider Enumeration Date	:	02/04/2008
Last Update Date	:	01/27/2011

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