Organization
MID STATE ARTIFICIAL LIMB CO, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TROY LUSTER (PRESIDENT)
(601) 981-2229
Entity
Organization
Contact information
Practice address
4455 MEDGAR EVERS BLVD, JACKSON, MS 39213-5202
(601) 981-2229
(601) 362-2129
Mailing address
PO BOX 31092, JACKSON, MS 39286-1092
(601) 981-2229
(601) 362-2129
Taxonomy
Speciality
Code
Description
License number
State
335E00000X
Prosthetic/Orthotic Supplier
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00040105
—
MS
Enumeration date
10/03/2006
Last updated
11/09/2010
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