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Organization

DAYTON ARTIFICIAL LIMB CLINIC, INC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
MR. TRACY CLAY SLEMKER CPO (PRESIDENT)
(937) 898-2200
Entity
Organization

Contact information

Practice address
700 HARCO DR, CLAYTON, OH 45315-8793
(937) 898-2200
(936) 832-5361
Mailing address
700 HARCO DR, CLAYTON, OH 45315-8793
(937) 898-2200
(937) 832-5361

Taxonomy

Speciality
Code
Description
License number
State
335E00000X
Prosthetic/Orthotic Supplier
Primary
CPO1502
OH
335E00000X
Prosthetic/Orthotic Supplier
LP0114
OH

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
000000020050
ANTHEM
OH
05
2009589
OH
01
311468023-00
BWC
OH
Enumeration date
06/13/2007
Last updated
10/21/2014
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