MEDICARE: ABANA ORTHOTICS & PROSTHETICS 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	335E00000X	Prosthetic/Orthotic Supplier		LA

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	G0568	OTHER	LA	BCBS OF LOUISIANA

General Provider Information

NPI Number	:	1770621922
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ABANA ORTHOTICS & PROSTHETICS INC

Provider Business Mailing Address
First Line	:	1419 PETERMAN DR
Second Line	:
City	:	ALEXANDRIA
State	:	LA
Zip	:	71301-3433
Country	:	US
Telephone Number	:	318-767-1929
Fax Number	:	318-767-1385

Provider Business Practice Location Address
First Line	:	1419 PETERMAN DR
Second Line	:
City	:	ALEXANDRIA
State	:	LA
Zip	:	71301-3433
Country	:	US
Telephone Number	:	318-767-1929
Fax Number	:	318-767-1385

Authorized Official
Title or Position	:	OWNER-PRESIDENT
Name	:	MR. CESAR SALIM LUTFALLAH
Credential	:	CPO, BOCPO, CPED
Telephone Number	:	318-767-1929

Provider Enumeration Date	:	02/01/2007
Last Update Date	:	08/27/2007

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