Provider Demographics
NPI:1669935292
Name:LISTON PROSTHETICS, LLC
Entity type:Organization
Organization Name:LISTON PROSTHETICS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CERTIFIED PROSTHETIST
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:LISTON
Authorized Official - Suffix:
Authorized Official - Credentials:CP
Authorized Official - Phone:385-425-3960
Mailing Address - Street 1:5292 S COLLEGE DR STE 103
Mailing Address - Street 2:
Mailing Address - City:MURRAY
Mailing Address - State:UT
Mailing Address - Zip Code:84123-2959
Mailing Address - Country:US
Mailing Address - Phone:385-425-3960
Mailing Address - Fax:385-425-3965
Practice Address - Street 1:5292 S COLLEGE DR STE 103
Practice Address - Street 2:
Practice Address - City:MURRAY
Practice Address - State:UT
Practice Address - Zip Code:84123-2959
Practice Address - Country:US
Practice Address - Phone:385-425-3960
Practice Address - Fax:385-425-3965
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-10
Last Update Date:2019-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier