Provider Demographics
NPI:1730164534
Name:FARRELL PROSTHETICS LLC
Entity type:Organization
Organization Name:FARRELL PROSTHETICS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:DENNIS
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:FARRELL
Authorized Official - Suffix:
Authorized Official - Credentials:CP
Authorized Official - Phone:414-259-1950
Mailing Address - Street 1:1011 N MAYFAIR RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:WAUWATOSA
Mailing Address - State:WI
Mailing Address - Zip Code:53226-3431
Mailing Address - Country:US
Mailing Address - Phone:414-259-1950
Mailing Address - Fax:414-259-1533
Practice Address - Street 1:1011 N MAYFAIR RD
Practice Address - Street 2:SUITE 100
Practice Address - City:WAUWATOSA
Practice Address - State:WI
Practice Address - Zip Code:53226-3431
Practice Address - Country:US
Practice Address - Phone:414-259-1950
Practice Address - Fax:414-259-1533
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-14
Last Update Date:2011-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI41788400Medicaid
WI4453600001Medicare NSC
WI4453600001Medicare Oscar/Certification