Provider Demographics
NPI:1396702718
Name:ARTIFICIAL LIMB SPECIALISTS LLC
Entity type:Organization
Organization Name:ARTIFICIAL LIMB SPECIALISTS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:PACK
Authorized Official - Suffix:
Authorized Official - Credentials:CP
Authorized Official - Phone:602-745-2080
Mailing Address - Street 1:7600 N. 15TH ST.
Mailing Address - Street 2:SUITE 105
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85020-4330
Mailing Address - Country:US
Mailing Address - Phone:602-745-2080
Mailing Address - Fax:602-745-2074
Practice Address - Street 1:2058 S DOBSON RD
Practice Address - Street 2:SUITE 17
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85202-6454
Practice Address - Country:US
Practice Address - Phone:480-969-3999
Practice Address - Fax:480-730-2750
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-28
Last Update Date:2020-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ1286660002Medicare NSC