Basic Information
| Provider Information | |||||||||
| NPI: | 1245257047 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ABLE II PROSTHETICS AND ORTHOTICS | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 22832 | ||||||||
| Address2: | |||||||||
| City: | LINCOLN | ||||||||
| State: | NE | ||||||||
| PostalCode: | 685422832 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4024838898 | ||||||||
| FaxNumber: | 6053739971 | ||||||||
| Practice Location | |||||||||
| Address1: | 2222 S 16TH ST STE 220 | ||||||||
| Address2: | |||||||||
| City: | LINCOLN | ||||||||
| State: | NE | ||||||||
| PostalCode: | 685023764 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4024838898 | ||||||||
| FaxNumber: | 4024355504 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/16/2006 | ||||||||
| LastUpdateDate: | 04/20/2022 | ||||||||
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| AuthorizedOfficialLastName: | PIRO | ||||||||
| AuthorizedOfficialFirstName: | MARK | ||||||||
| AuthorizedOfficialMiddleName: | A | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER/PROVIDER | ||||||||
| AuthorizedOfficialTelephone: | 4024838898 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | CPO | ||||||||
| NPICertificationDate: | 04/20/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1744P3200X | N | 193400000X SINGLE SPECIALTY GROUP | Other Service Providers | Specialist | Prosthetics Case Management | 335E00000X | Y | Suppliers | Prosthetic/Orthotic Supplier |
ID Information
| ID | Type | State | Issuer | Description | 0526467 | 05 | IA | MEDICAID |