Organization
MOUNTAIN STATE PROSTHETICS, LLC
Active
Other names
Mountain State Prosthetics, LLC
Organization subpart
No
Provider details
NPI number
Authorized official
DAVID P. HANSFORD CPO (MANAGER)
(304) 344-5593
Entity
Organization
Contact information
Practice address
216 BROOKS ST, SUITE 100, CHARLESTON, WV 25301-1828
(304) 344-5593
(304) 344-5595
Mailing address
216 BROOKS ST, SUITE 100, CHARLESTON, WV 25301-1828
(304) 344-5593
(304) 344-5595
Taxonomy
Speciality
Code
Description
License number
State
335E00000X
Prosthetic/Orthotic Supplier
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0147696000
—
WV
Enumeration date
05/23/2006
Last updated
03/15/2012
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