Organization
DAYTON ARTIFICIAL LIMB CLINIC, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. LUCI BUSCH CP LP (V P OF OPERATIONS)
(937) 898-2200
Entity
Organization
Contact information
Practice address
700 HARCO DR, CLAYTON, OH 45315-8793
(937) 898-2000
(937) 832-5361
Mailing address
700 HARCO DR, CLAYTON, OH 45315-8793
(937) 898-2000
(937) 832-5361
Taxonomy
Speciality
Code
Description
License number
State
335E00000X
Prosthetic/Orthotic Supplier
Primary
CPO1502
OH
335E00000X
Prosthetic/Orthotic Supplier
LPO114
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000020050
ANTHEM
OH
05
—
2009589
—
OH
Enumeration date
08/09/2005
Last updated
10/22/2014
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