NPIMap

Organization Active NPI

Snell Prosthetic & Orthotic Laboratory

  • Prosthetic/Orthotic Supplier
  • Russellville, AR
National Provider Identifier
1609851872
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
2300 W Main St
Russellville, AR 72801-2529
Phone
(479) 968-1713
Fax
(479) 890-4333
NPI assigned
Dec 10, 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

2300 W Main St
Russellville, AR 72801-2529

Mailing address

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

Other identifiers 1

IdentifierTypeStateIssuer
148050716MedicaidAR

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20100930000017 AR DME Supplier - Medical Supply Company With Orthotic-ProstheticDME Supplier - Pedorthic Personnel 8426175936 Practice locations: Russellville, 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 Laborat2300 W Main St, Russellville, AR 72801-2529(479) 968-1713 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

2300 W Main St
Russellville, AR 72801
Phone (479) 968-1713

NPI Registry JSON

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

{
    "created_epoch": "1134172800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1704326400000",
    "number": "1609851872",
    "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": "501-664-1708"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2300 W MAIN ST",
            "city": "RUSSELLVILLE",
            "state": "AR",
            "postal_code": "728012529",
            "telephone_number": "479-968-1713",
            "fax_number": "479-890-4333"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SNELL PROSTHETIC & ORTHOTIC LABORATORY",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-12-10",
        "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": "148050716",
            "state": "AR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Russellville, 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.