Provider Demographics
NPI:1437484821
Name:INNOVATIVE PROSTHETICS LLC
Entity type:Organization
Organization Name:INNOVATIVE PROSTHETICS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:J
Authorized Official - Middle Name:CURT
Authorized Official - Last Name:PATTON
Authorized Official - Suffix:III
Authorized Official - Credentials:CPO
Authorized Official - Phone:228-313-7667
Mailing Address - Street 1:6086 U S HIGHWAY 49
Mailing Address - Street 2:SUITE B
Mailing Address - City:HATTIESBURG
Mailing Address - State:MS
Mailing Address - Zip Code:39401-7340
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6086 U S HIGHWAY 49
Practice Address - Street 2:SUITE B
Practice Address - City:HATTIESBURG
Practice Address - State:MS
Practice Address - Zip Code:39401-7340
Practice Address - Country:US
Practice Address - Phone:228-313-7667
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-02
Last Update Date:2009-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier