Organization
PROMYSE-PROSTHETIC ORTHOTIC GROUP
Active
Other names
CERTIFIED LIMB AND BRACE
Organization subpart
No
Provider details
NPI number
Authorized official
MR. HENRY J RICHTER JR. CPO, LPO (PRESIDENT)
(318) 636-9145
Entity
Organization
Contact information
Practice address
3227 PORTLAND AVE, SHREVEPORT, LA 71103-4026
(318) 636-9145
(318) 636-3746
Mailing address
3227 PORTLAND AVE, SHREVEPORT, LA 71103-4026
(318) 636-9145
(318) 636-3746
Taxonomy
Speciality
Code
Description
License number
State
335E00000X
Prosthetic/Orthotic Supplier
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00440756
—
MS
05
—
075470701
—
TX
05
—
100802440A
—
OK
05
—
120085716
—
AR
05
—
1370371
—
LA
Enumeration date
02/13/2006
Last updated
09/10/2020
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