Provider Demographics
NPI:1730232778
Name:AMPUCARE, LLC
Entity type:Organization
Organization Name:AMPUCARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CERTIFIED PROSTHETIST
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:ANTHONY
Authorized Official - Last Name:HESTER
Authorized Official - Suffix:
Authorized Official - Credentials:CP
Authorized Official - Phone:601-259-7233
Mailing Address - Street 1:300 HIGHLAND BLVD
Mailing Address - Street 2:SUITE A
Mailing Address - City:NATCHEZ
Mailing Address - State:MS
Mailing Address - Zip Code:39120-4600
Mailing Address - Country:US
Mailing Address - Phone:601-442-5503
Mailing Address - Fax:601-442-5504
Practice Address - Street 1:300 HIGHLAND BLVD
Practice Address - Street 2:SUITE A
Practice Address - City:NATCHEZ
Practice Address - State:MS
Practice Address - Zip Code:39120-4600
Practice Address - Country:US
Practice Address - Phone:601-442-5503
Practice Address - Fax:601-442-5504
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-22
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS08826559Medicaid
=========OtherBLUECROSS & BLUESHIELD
5906250001Medicare NSC