Prosthetic Design Inc

Primary specialty

Prosthetic/Orthotic SupplierTaxonomy code 335E00000X

License

17156319 Issued in MO

Legal business name

PROSTHETIC DESIGN INC

Practice address

142 Jungermann Road
St. Peters, MO 63376

Phone

(314) 535-5359

Fax

(314) 535-5488

NPI assigned

Sep 15, 2008

Organization subpart

No

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

Authorized official

Name

Mrs. Deborah J Wilson

Title

Owner/V.P.

Phone

(314) 535-5359

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

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

{
    "created_epoch": "1221436800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1221436800000",
    "number": "1114176138",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 444",
            "city": "BALLWIN",
            "state": "MO",
            "postal_code": "63022",
            "telephone_number": "314-535-5359",
            "fax_number": "314-535-5488"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "142 JUNGERMANN ROAD",
            "city": "ST. PETERS",
            "state": "MO",
            "postal_code": "63376",
            "telephone_number": "314-535-5359",
            "fax_number": "314-535-5488"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROSTHETIC DESIGN INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-09-15",
        "last_updated": "2008-09-15",
        "status": "A",
        "authorized_official_last_name": "WILSON",
        "authorized_official_first_name": "DEBORAH",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "OWNER/V.P.",
        "authorized_official_telephone_number": "314-535-5359",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "335E00000X",
            "taxonomy_group": "",
            "desc": "Prosthetic/Orthotic Supplier",
            "state": "MO",
            "license": "17156319",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "624794301",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• All providers in St. Peters, MO
• Prosthetic/Orthotic Supplier in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 15, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.