Amputee Prosthetic Clinic, Company

Primary specialty

Prosthetic/Orthotic SupplierTaxonomy code 335E00000X

License

CP2910 Issued in GA

Legal business name

AMPUTEE PROSTHETIC CLINIC, COMPANY

Practice address

2400 Bellevue Rd Ste 22
Dublin, GA 31021-2889

Phone

(478) 246-1694

Fax

(478) 246-1690

NPI assigned

Jul 7, 2006

Last updated

Jan 19, 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

Mrs. Pamela S Young

Title

Off. Manager/ Business Owner

Phone

(478) 474-5678

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• AMPUTEE PROSTHETIC CLINIC Other name

Medicare fee-for-service enrollment

Enrolled in GA

Enrollment records 1

Other NPIs with the same Medicare PAC ID 2

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

• Amputee Prosthetic Clinic, Co.

  • Prosthetic/Orthotic Supplier
  • Macon, GA
  • NPI 1013949247

  4789895160

  Same PAC ID
• Amputee Prosthetic Clinic, Co.

  • Prosthetic/Orthotic Supplier
  • Tifton, GA
  • NPI 1578590972

  4789895160

  Same PAC ID

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

Tax ID family

Amputee Prosthetic Clinic3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

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

• Amputee Prosthetic Clinic, Co.

  • Prosthetic/Orthotic Supplier
  • Macon, GA
  • NPI 1013949247
  NPD tax ID
• Amputee Prosthetic Clinic, Co.

  • Prosthetic/Orthotic Supplier
  • Tifton, GA
  • NPI 1578590972
  NPD tax ID

Locations

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

{
    "created_epoch": "1152230400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1705622400000",
    "number": "1215969498",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4900 MERCER UNIVERSITY DR",
            "city": "MACON",
            "state": "GA",
            "postal_code": "312106239",
            "telephone_number": "478-474-5678",
            "fax_number": "478-474-5018"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2400 BELLEVUE RD STE 22",
            "city": "DUBLIN",
            "state": "GA",
            "postal_code": "310212889",
            "telephone_number": "478-246-1694",
            "fax_number": "478-246-1690"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AMPUTEE PROSTHETIC CLINIC, COMPANY",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-07",
        "last_updated": "2024-01-19",
        "certification_date": "2024-01-19",
        "status": "A",
        "authorized_official_last_name": "YOUNG",
        "authorized_official_first_name": "PAMELA",
        "authorized_official_middle_name": "S",
        "authorized_official_title_or_position": "OFF. MANAGER/ BUSINESS OWNER",
        "authorized_official_telephone_number": "478-474-5678",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "335E00000X",
            "taxonomy_group": "",
            "desc": "Prosthetic/Orthotic Supplier",
            "state": "GA",
            "license": "CP2910",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "408774069C",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "AMPUTEE PROSTHETIC CLINIC",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

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• Prosthetic/Orthotic Supplier in Dublin, GA
• Providers in Dublin, GA by specialty
• Prosthetic/Orthotic Supplier in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 19, 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.