Provider Demographics
NPI:1285330696
Name:ROADRUNNER PROSTHETICS INC.
Entity type:Organization
Organization Name:ROADRUNNER PROSTHETICS INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROSTHETIST
Authorized Official - Prefix:
Authorized Official - First Name:MACKINLEY
Authorized Official - Middle Name:SPENCER
Authorized Official - Last Name:BURRELL
Authorized Official - Suffix:
Authorized Official - Credentials:CP
Authorized Official - Phone:512-922-4620
Mailing Address - Street 1:42212 N 41ST DR STE 105
Mailing Address - Street 2:
Mailing Address - City:ANTHEM
Mailing Address - State:AZ
Mailing Address - Zip Code:85086-3815
Mailing Address - Country:US
Mailing Address - Phone:623-352-4520
Mailing Address - Fax:
Practice Address - Street 1:42212 N 41ST DR STE 105
Practice Address - Street 2:
Practice Address - City:ANTHEM
Practice Address - State:AZ
Practice Address - Zip Code:85086-3815
Practice Address - Country:US
Practice Address - Phone:623-352-4520
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-07
Last Update Date:2023-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
No224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetistGroup - Single Specialty