Gallup Limb and Brace Co Inc

Primary specialty

ProsthetistTaxonomy code 224P00000X

License

CP002174 Issued in NU

Legal business name

GALLUP LIMB AND BRACE CO INC

Practice address

927 West Aztec Avenue
Gallup, NM 87301

Phone

(505) 722-5756

Fax

(505) 722-6726

NPI assigned

Oct 26, 2006

Last updated

Jan 25, 2024By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Justin Marshall, ABC COA

Title

President/Owner

Phone

(505) 722-5756

Specialties & licenses 1

Addresses

Other identifiers 2

Other names 1

• Gallup Artificial Limb and Brace Co Inc Other name

Medicare fee-for-service enrollment

Enrolled in NM

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

Medicare medical equipment & supply locations

Locations

Practitioners 7

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Brent M Cutshall, MD

  • Critical Care Medicine (Internal Medicine) Physician
  • Phoenix, AZ
  • NPI 1225079635
  NPD (past)
• Stephanie Fountain, MD

  • Critical Care Medicine (Internal Medicine) Physician
  • Fargo, ND
  • NPI 1528405917
  NPD (past)
• Lisa Ann Graham, M.D.

  • Critical Care Medicine (Internal Medicine) Physician
  • Prescott, AZ
  • NPI 1386955623
  NPD (past)
• Jennifer Elizabeth Hall, D.O.

  • Critical Care Medicine (Internal Medicine) Physician
  • Prescott, AZ
  • NPI 1417022559
  NPD (past)
• Douglas W Mapel, MD

  • Critical Care Medicine (Internal Medicine) Physician
  • Prescott, AZ
  • NPI 1497730451
  NPD (past)
• Elijah Michael Poulos, MD

  • Critical Care Medicine (Internal Medicine) Physician
  • Prescott, AZ
  • NPI 1386871325
  NPD (past)
• Ernst-Gilbert Schreiber, MD

  • Pulmonary Disease Physician
  • Bremerton, WA
  • NPI 1548350168
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1161820800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1706140800000",
    "number": "1114002219",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "927 WEST AZTEC AVENUE",
            "city": "GALLUP",
            "state": "NM",
            "postal_code": "87301",
            "telephone_number": "505-722-5756",
            "fax_number": "505-722-6726"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "927 WEST AZTEC AVENUE",
            "city": "GALLUP",
            "state": "NM",
            "postal_code": "87301",
            "telephone_number": "505-722-5756",
            "fax_number": "505-722-6726"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GALLUP LIMB AND BRACE CO INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-26",
        "last_updated": "2024-01-25",
        "certification_date": "2021-09-07",
        "status": "A",
        "authorized_official_last_name": "MARSHALL",
        "authorized_official_first_name": "JUSTIN",
        "authorized_official_title_or_position": "PRESIDENT/OWNER",
        "authorized_official_telephone_number": "505-722-5756",
        "authorized_official_credential": "ABC COA"
    },
    "taxonomies": [
        {
            "code": "224P00000X",
            "taxonomy_group": "",
            "desc": "Prosthetist",
            "state": "NU",
            "license": "CP002174",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "T6269",
            "state": "NM"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "307852",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Gallup Artificial Limb and Brace Co Inc",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Gallup Eye Group LLC
• Gallup Health Facilities LP (Red Rocks Care Center)
• Gallup Indian Med Center Pharmacy
• Gallup Indian Medical Center
• Gallup Indian Medical Center
• Gallup McKinley County Schools
• Gallup McKinley County Schools
• Gallup Med Flight, LLC (Gallup Med Flight)
• Gallup Nursing & Rehabilitation LLC (Gallup Nursing & Rehabilitation)
• Gallup Outpatient Treatment Center

• Prosthetist in Gallup, NM
• Providers in Gallup, NM by specialty
• Prosthetist in New Mexico

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 25, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.