Four Corners Artificial Limb & Brace

Primary specialty

Durable Medical Equipment & Medical SuppliesTaxonomy code 332B00000X

Legal business name

FOUR CORNERS ARTIFICIAL LIMB & BRACE

Practice address

653 W Broadway
Farmington, NM 87401-5910

Phone

(505) 326-6305

Fax

(505) 326-6325

NPI assigned

Aug 10, 2006

Last updated

Feb 16, 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

Mr. Justin Howard Marshall

Title

Owner, President

Phone

(505) 326-6305

Specialties & licenses 2

Addresses

Other identifiers 1

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

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

{
    "created_epoch": "1155168000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1708041600000",
    "number": "1396756987",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "653 W BROADWAY",
            "city": "FARMINGTON",
            "state": "NM",
            "postal_code": "874015910",
            "telephone_number": "505-326-6305"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "653 W BROADWAY",
            "city": "FARMINGTON",
            "state": "NM",
            "postal_code": "874015910",
            "telephone_number": "505-326-6305",
            "fax_number": "505-326-6325"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FOUR CORNERS ARTIFICIAL LIMB & BRACE",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-10",
        "last_updated": "2024-02-16",
        "certification_date": "2024-02-16",
        "status": "A",
        "authorized_official_last_name": "MARSHALL",
        "authorized_official_first_name": "JUSTIN",
        "authorized_official_middle_name": "HOWARD",
        "authorized_official_title_or_position": "OWNER, PRESIDENT",
        "authorized_official_telephone_number": "505-326-6305",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "335E00000X",
            "taxonomy_group": "",
            "desc": "Prosthetic/Orthotic Supplier",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "T6251",
            "state": "NM"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Four Corners Compounding
• Four Corners Family Dental LLC
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• Four Corners Gastroenterology Consultants PC
• Four Corners Heart and Lung Institute PC

• Durable Medical Equipment & Medical Supplies in Farmington, NM
• Providers in Farmington, NM by specialty
• Durable Medical Equipment & Medical Supplies in New Mexico

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 16, 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.