MEDICARE: LIMB CENTER 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
2	1744P3200X	Prosthetics Case Management

General Provider Information

NPI Number	:	1548787930
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LIMB CENTER LLC

Provider Business Mailing Address
First Line	:	637 E COTTONWOOD LN
Second Line	:
City	:	CASA GRANDE
State	:	AZ
Zip	:	85122-2023
Country	:	US
Telephone Number	:	520-413-1554
Fax Number	:	520-413-1549

Provider Business Practice Location Address
First Line	:	3020 N 44TH ST
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85018-7206
Country	:	US
Telephone Number	:	602-900-1733
Fax Number	:	602-900-1759

Authorized Official
Title or Position	:	MEMBER/OWNER
Name	:	MR. DAVE SHARMA
Credential	:	CP
Telephone Number	:	520-413-1554

Provider Enumeration Date	:	08/25/2017
Last Update Date	:	08/25/2017

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