Organization
FOUR CORNERS ARTIFICIAL LIMB & BRACE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JUSTIN HOWARD MARSHALL (OWNER, PRESIDENT)
(505) 326-6305
Entity
Organization
Contact information
Practice address
653 W BROADWAY, FARMINGTON, NM 87401-5910
(505) 326-6305
(505) 326-6325
Mailing address
653 W BROADWAY, FARMINGTON, NM 87401-5910
(505) 326-6305
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
—
—
335E00000X
Prosthetic/Orthotic Supplier
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
T6251
—
NM
Enumeration date
08/10/2006
Last updated
02/16/2024
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