Provider Demographics
NPI:1528157914
Name:LIMBCARE PROSTHETICS & ORTHOTICS LLC.
Entity type:Organization
Organization Name:LIMBCARE PROSTHETICS & ORTHOTICS LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROSTHETIST/ORTHOTIST
Authorized Official - Prefix:MR
Authorized Official - First Name:EDMOND
Authorized Official - Middle Name:JUDE
Authorized Official - Last Name:RESTIVO
Authorized Official - Suffix:JR
Authorized Official - Credentials:CPO
Authorized Official - Phone:985-726-9052
Mailing Address - Street 1:1350 LINDBERG DR
Mailing Address - Street 2:
Mailing Address - City:SLIDELL
Mailing Address - State:LA
Mailing Address - Zip Code:70458-8054
Mailing Address - Country:US
Mailing Address - Phone:985-726-9052
Mailing Address - Fax:985-726-9053
Practice Address - Street 1:1350 LINDBERG DR
Practice Address - Street 2:
Practice Address - City:SLIDELL
Practice Address - State:LA
Practice Address - Zip Code:70458-8054
Practice Address - Country:US
Practice Address - Phone:985-726-9052
Practice Address - Fax:985-726-9053
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALCPO02238261QM1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1590304Medicaid
LA5492480001Medicare ID - Type UnspecifiedPROVIDER #