Provider Demographics
NPI:1356539258
Name:PROFAB UNLIMITED, INC.
Entity type:Organization
Organization Name:PROFAB UNLIMITED, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:SHANE
Authorized Official - Last Name:DUNIGAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:937-832-0343
Mailing Address - Street 1:343 SMITH DR
Mailing Address - Street 2:
Mailing Address - City:CLAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45315-8705
Mailing Address - Country:US
Mailing Address - Phone:937-832-0343
Mailing Address - Fax:937-832-2075
Practice Address - Street 1:343 SMITH DR
Practice Address - Street 2:
Practice Address - City:CLAYTON
Practice Address - State:OH
Practice Address - Zip Code:45315-8705
Practice Address - Country:US
Practice Address - Phone:937-832-0343
Practice Address - Fax:937-832-2075
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-05
Last Update Date:2007-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHLP.207335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier