MEDICARE: SCOTT SABOLICH PROSTHETICS & RESEARCH 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	CP2626	OK

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	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1417244195
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SCOTT SABOLICH PROSTHETICS & RESEARCH LLC

Provider Business Mailing Address
First Line	:	PO BOX 16231
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73113-2231
Country	:	US
Telephone Number	:	405-841-6800
Fax Number	:	405-841-9885

Provider Business Practice Location Address
First Line	:	15900 PRESTON RD
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75248-3551
Country	:	US
Telephone Number	:	877-226-5424
Fax Number	:	405-841-9885

Authorized Official
Title or Position	:	EVP OF LICENSURE AND COMPLIANCE
Name	:	KIMBERLY LEWIS
Credential	:	CPCO
Telephone Number	:	512-806-2861

Provider Enumeration Date	:	07/01/2011
Last Update Date	:	10/27/2022

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