Provider Demographics
NPI:1538795364
Name:FAITHFUL LIMBS PROSTHETICS
Entity type:Organization
Organization Name:FAITHFUL LIMBS PROSTHETICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPERATIONS MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CHRISTINA
Authorized Official - Middle Name:
Authorized Official - Last Name:HARRISON JEFFERSON
Authorized Official - Suffix:
Authorized Official - Credentials:CDME
Authorized Official - Phone:601-720-1911
Mailing Address - Street 1:114 HERRING DR
Mailing Address - Street 2:
Mailing Address - City:RAYMOND
Mailing Address - State:MS
Mailing Address - Zip Code:39154-9646
Mailing Address - Country:US
Mailing Address - Phone:601-720-1911
Mailing Address - Fax:
Practice Address - Street 1:114 HERRING DR
Practice Address - Street 2:
Practice Address - City:RAYMOND
Practice Address - State:MS
Practice Address - Zip Code:39154-9646
Practice Address - Country:US
Practice Address - Phone:601-720-1911
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-03-12
Last Update Date:2020-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetistGroup - Single Specialty