MEDICARE: AMIGOS 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

General Provider Information

NPI Number	:	1790580363
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AMIGOS ORTHOTICS & PROSTHETICS INC.

Provider Business Mailing Address
First Line	:	5287 S HIGHWAY 95 STE I
Second Line	:
City	:	FORT MOHAVE
State	:	AZ
Zip	:	86426-9220
Country	:	US
Telephone Number	:	877-314-1086
Fax Number	:	866-592-3002

Provider Business Practice Location Address
First Line	:	5287 HWY 95 STE I
Second Line	:
City	:	FORT MOHAVE
State	:	AZ
Zip	:	86426-9220
Country	:	US
Telephone Number	:	626-622-3359
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	ALPHA ISCANDARI SANUSI
Credential	:
Telephone Number	:	626-622-3359

Provider Enumeration Date	:	02/17/2025
Last Update Date	:	05/18/2026

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