NPIMap

Organization Active NPI

Snell Prosthetic & Orthotic Laboratory

  • Prosthetic/Orthotic Supplier
  • Little Rock, AR
National Provider Identifier
1215912779
Registry record updated Jan 4, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Prosthetic/Orthotic SupplierTaxonomy code 335E00000X
License
04734178001 Issued in AR
Legal business name
SNELL PROSTHETIC & ORTHOTIC LABORATORY
Practice address
625 N University Ave
Little Rock, AR 72205-2917
Phone
(501) 664-2624
Fax
(501) 664-1708
NPI assigned
Dec 7, 2005
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 4, 2024

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

Authorized official

Name
Brant E. Snell, LOPA
Title
Coo
Phone
(501) 664-2624

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Prosthetic/Orthotic Supplier 335E00000X 04734178001 AR Primary

Addresses

Primary practice location

625 N University Ave
Little Rock, AR 72205-2917

Mailing address

625 N University Ave
Little Rock, AR 72205-2917
Phone (501) 664-2624

Other identifiers 1

IdentifierTypeStateIssuer
104335716MedicaidAR

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AR

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20100930075377 AR DME Supplier - Medical Supply Company With Orthotic-ProstheticDME Supplier - Medical Supply Company With Orthotic PersonnelDME Supplier - Medical Supply Company With Prosthetic PersonnelDME Supplier - Orthotic PersonnelDME Supplier - Prosthetic Personnel 8426175936 Practice locations: Little Rock, AR

Other NPIs with the same Medicare PAC ID 10

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Laboratory certificates & supplier records

Derived by NPIMap

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

SupplierSuppliesMedicare assignment
Snell Prosthetic & Orthotic Lab.625 N University Ave, Little Rock, AR 72205-2917(501) 664-2624 Traction Equipment|Canes and/or Crutches|Walkers|Orthoses: Custom Fabricated|Orthoses: Prefabricated (Non-Custom Fabricated)|Orthoses: Off-The-Shelf|Breast Prostheses and/or Accessories|Limb Prostheses|Diabetic Shoes and Inserts|Diabetic Shoes/Inserts - Custom|Lymphedema Compression Treatment Items Does not accept assignmentParticipating since Jan 1, 2016

National Provider Directory

National Provider Directory
Tax ID family
Snell Proth Orth Lab10 organizations share this tax ID, including this one

Other organizations with this tax ID 9

Organizations that report the same tax identification number in the National Provider Directory.

Locations

612 Office Park Dr
Ste 4
Bryant, AR 72022
Phone (501) 847-8887

2915 Dave Ward Dr
Conway, AR 72034

416 W Main St
Ste B
El Dorado, AR 71730
Phone (870) 875-9900

416 W Main St
El Dorado, AR 71730
Phone (870) 875-9000

1792 E Joyce Blvd
Ste 2A
Fayetteville, AR 72703

147 Section Line Rd
Ste C
Hot Springs National Park, AR 71913
Phone (501) 525-7943

333 Highway 5 N
Ste 4
Mountain Home, AR 72653
Phone (870) 424-7010

4300 Landers Rd
#B
North Little Rock, AR 72117
Phone (501) 945-5462

NPI Registry JSON

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

{
    "created_epoch": "1133913600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1704326400000",
    "number": "1215912779",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "625 N UNIVERSITY AVE",
            "city": "LITTLE ROCK",
            "state": "AR",
            "postal_code": "722052917",
            "telephone_number": "501-664-2624",
            "fax_number": "501-664-1705"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "625 N UNIVERSITY AVE",
            "city": "LITTLE ROCK",
            "state": "AR",
            "postal_code": "722052917",
            "telephone_number": "501-664-2624",
            "fax_number": "501-664-1708"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SNELL PROSTHETIC & ORTHOTIC LABORATORY",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-12-07",
        "last_updated": "2024-01-04",
        "certification_date": "2024-01-04",
        "status": "A",
        "authorized_official_last_name": "SNELL",
        "authorized_official_first_name": "BRANT",
        "authorized_official_middle_name": "E.",
        "authorized_official_title_or_position": "COO",
        "authorized_official_telephone_number": "501-664-2624",
        "authorized_official_credential": "LOPA"
    },
    "taxonomies": [
        {
            "code": "335E00000X",
            "taxonomy_group": "",
            "desc": "Prosthetic/Orthotic Supplier",
            "state": "AR",
            "license": "04734178001",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "104335716",
            "state": "AR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Little Rock, AR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 4, 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.