Provider Demographics
NPI:1174932875
Name:DARBY ORTHOTICS AND PROSTHETICS, LLC
Entity type:Organization
Organization Name:DARBY ORTHOTICS AND PROSTHETICS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:L
Authorized Official - Last Name:DARBY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:573-777-4701
Mailing Address - Street 1:3407 BERRYWOOD DR STE 203
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MO
Mailing Address - Zip Code:65201-6500
Mailing Address - Country:US
Mailing Address - Phone:573-777-4701
Mailing Address - Fax:573-777-4702
Practice Address - Street 1:3407 BERRYWOOD DR STE 203
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65201-6500
Practice Address - Country:US
Practice Address - Phone:573-777-4701
Practice Address - Fax:573-777-4702
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-06
Last Update Date:2016-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO7258750001Medicare PIN