Organization
PREVAIL PROSTHETICS AND ORTHOTICS, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CHRISTI HUDSON (BUSINESS MANAGER)
(260) 483-5219
Entity
Organization
Contact information
Practice address
7735 W JEFFERSON BLVD, SUITE C, FORT WAYNE, IN 46804-4135
(260) 483-5219
(260) 484-2291
Mailing address
7735 W JEFFERSON BLVD, SUITE C, FORT WAYNE, IN 46804-4135
(260) 483-5219
(260) 484-2291
Taxonomy
Speciality
Code
Description
License number
State
335E00000X
Prosthetic/Orthotic Supplier
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200405280
—
IN
Enumeration date
02/09/2007
Last updated
11/29/2018
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