Provider Demographics
NPI:1679156699
Name:3D PROSTHETICS, LLC
Entity type:Organization
Organization Name:3D PROSTHETICS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SR. ADMINISTRATIVE SPECIALIST
Authorized Official - Prefix:MS
Authorized Official - First Name:LUCINDA
Authorized Official - Middle Name:B
Authorized Official - Last Name:BUSCH
Authorized Official - Suffix:
Authorized Official - Credentials:CP, LP
Authorized Official - Phone:765-756-5014
Mailing Address - Street 1:2011 CHESTER BLVD
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:IN
Mailing Address - Zip Code:47374-1214
Mailing Address - Country:US
Mailing Address - Phone:765-488-1165
Mailing Address - Fax:
Practice Address - Street 1:2011 CHESTER BLVD
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:IN
Practice Address - Zip Code:47374-1214
Practice Address - Country:US
Practice Address - Phone:765-488-1165
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-29
Last Update Date:2023-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetistGroup - Multi-Specialty
No335E00000XSuppliersProsthetic/Orthotic SupplierGroup - Multi-Specialty