Provider Demographics
NPI:1447363593
Name:LIMA BRACE & LIMB, INC
Entity type:Organization
Organization Name:LIMA BRACE & LIMB, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:KIRK
Authorized Official - Middle Name:
Authorized Official - Last Name:WISE
Authorized Official - Suffix:
Authorized Official - Credentials:LPO
Authorized Official - Phone:419-224-4841
Mailing Address - Street 1:PO BOX 569
Mailing Address - Street 2:
Mailing Address - City:LIMA
Mailing Address - State:OH
Mailing Address - Zip Code:45802-0569
Mailing Address - Country:US
Mailing Address - Phone:419-224-4841
Mailing Address - Fax:419-228-8138
Practice Address - Street 1:1000 BELLEFONTAINE AVE
Practice Address - Street 2:
Practice Address - City:LIMA
Practice Address - State:OH
Practice Address - Zip Code:45804-2804
Practice Address - Country:US
Practice Address - Phone:419-224-4841
Practice Address - Fax:419-228-8138
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-15
Last Update Date:2012-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH02046044335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH5184349Medicaid
OH0319620003Medicare ID - Type Unspecified