NPIMap

Organization Active NPI

Snell Prosthetic & Orthotic Laboratory

  • Prosthetic/Orthotic Supplier
  • White Hall, AR
National Provider Identifier
1578807152
Registry record updated Jan 4, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Prosthetic/Orthotic SupplierTaxonomy code 335E00000X
Legal business name
SNELL PROSTHETIC & ORTHOTIC LABORATORY
Practice address
7500 Dollarway Rd Ste 202
White Hall, AR 71602-3085
Phone
(870) 534-1900
Fax
(870) 534-3187
NPI assigned
Nov 20, 2012
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 AR Primary

Addresses

Primary practice location

7500 Dollarway Rd Ste 202
White Hall, AR 71602-3085

Mailing address

2425 W 28TH Ave
Pine Bluff, AR 71603-5051
Phone (870) 534-1900

Other identifiers 1

IdentifierTypeStateIssuer
299136716MedicaidAR

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20130215000375 AR DME Supplier - Medical Supply Company With Orthotic PersonnelDME Supplier - Medical Supply Company With Prosthetic PersonnelDME Supplier - Orthotic PersonnelDME Supplier - Pedorthic PersonnelDME Supplier - Medical Supply Company With Pedorthic Personnel 8426175936 Practice locations: White Hall, 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 Laborat7500 Dollarway Rd, White Hall, AR 71602-3085(870) 534-1900 Traction Equipment|Canes and/or Crutches|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

2425 W 28th Ave
Pine Bluff, AR 71603
Phone (870) 534-1900

7500 Dollarway Rd
Ste 202
White Hall, AR 71602
Phone (870) 534-1900

NPI Registry JSON

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

{
    "created_epoch": "1353369600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1704326400000",
    "number": "1578807152",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2425 W 28TH AVE",
            "city": "PINE BLUFF",
            "state": "AR",
            "postal_code": "716035051",
            "telephone_number": "870-534-1900",
            "fax_number": "870-534-3187"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7500 DOLLARWAY RD STE 202",
            "city": "WHITE HALL",
            "state": "AR",
            "postal_code": "716023085",
            "telephone_number": "870-534-1900",
            "fax_number": "870-534-3187"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SNELL PROSTHETIC & ORTHOTIC LABORATORY",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-11-20",
        "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": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "299136716",
            "state": "AR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in White Hall, 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.