Provider Demographics
NPI:1366774457
Name:CERTIFIED BRACE AND LIMB
Entity type:Organization
Organization Name:CERTIFIED BRACE AND LIMB
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DONNY
Authorized Official - Middle Name:
Authorized Official - Last Name:KEELE
Authorized Official - Suffix:II
Authorized Official - Credentials:CPO
Authorized Official - Phone:660-826-3555
Mailing Address - Street 1:101 DUNDEE AVE
Mailing Address - Street 2:
Mailing Address - City:SEDALIA
Mailing Address - State:MO
Mailing Address - Zip Code:65301-2336
Mailing Address - Country:US
Mailing Address - Phone:660-826-3555
Mailing Address - Fax:660-826-9555
Practice Address - Street 1:101 DUNDEE AVE
Practice Address - Street 2:
Practice Address - City:SEDALIA
Practice Address - State:MO
Practice Address - Zip Code:65301-2336
Practice Address - Country:US
Practice Address - Phone:660-826-3555
Practice Address - Fax:660-826-9555
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-01
Last Update Date:2015-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO626234207Medicaid