NPIMap

Organization Active NPI

Custom Prosthetic & Orthotic

  • Prosthetic/Orthotic Supplier
  • Clinton, MS
National Provider Identifier
1710147301
Registry record updated Mar 15, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Prosthetic/Orthotic SupplierTaxonomy code 335E00000X
Legal business name
CUSTOM PROSTHETIC & ORTHOTIC
Practice address
801 E Northside Dr
Suite - D
Clinton, MS 39056-3663
Phone
(601) 906-1024
NPI assigned
Jun 17, 2008
Last updated
Mar 15, 2012By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 15, 2012

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

Authorized official

Name
Mrs. Johnnie Mae Owens, CHILD CARENPI 1740448802
Title
Owner President
Phone
(601) 906-1024

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

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

Addresses

Primary practice location

801 E Northside Dr
Suite - D
Clinton, MS 39056-3663

Mailing address

801 E Northside Dr
Suite - D
Clinton, MS 39056-3663
Phone (601) 906-1024

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1213660800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1331769600000",
    "number": "1710147301",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "801 E NORTHSIDE DR",
            "address_2": "SUITE - D",
            "city": "CLINTON",
            "state": "MS",
            "postal_code": "390563663",
            "telephone_number": "601-906-1024"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "801 E NORTHSIDE DR",
            "address_2": "SUITE - D",
            "city": "CLINTON",
            "state": "MS",
            "postal_code": "390563663",
            "telephone_number": "601-906-1024"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CUSTOM PROSTHETIC & ORTHOTIC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-06-17",
        "last_updated": "2012-03-15",
        "status": "A",
        "authorized_official_last_name": "OWENS",
        "authorized_official_first_name": "JOHNNIE",
        "authorized_official_middle_name": "MAE",
        "authorized_official_title_or_position": "OWNER PRESIDENT",
        "authorized_official_telephone_number": "601-906-1024",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "CHILD CARE"
    },
    "taxonomies": [
        {
            "code": "335E00000X",
            "taxonomy_group": "",
            "desc": "Prosthetic/Orthotic Supplier",
            "state": "MS",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Clinton, MS

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 15, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.