SPECIALTY BRACE & LIMB, INC.

Contacts

Phone	+1 407-740-7772
Fax	4075391791

Authorized person

Name	MS. SHERYL PRICE
Role	DIRECTOR OF REIMBURSEMENT
Phone	5034938288

Taxonomy

Taxonomy Code	332B00000X - Durable Medical Equipment & Medical Supplies
State	FL
Is Primary	No
Taxonomy Code	335E00000X - Prosthetic/Orthotic Supplier
State	FL
Is Primary	Yes

Other Provider Identifiers

Issuer	MEDICAID
Number	030823400
State	FL

File	View Page
Three-digit plan number (PN)	002
Effective date of plan	2008-01-01
Business code	453990
Sponsor’s telephone number	4077407772
Plan sponsor’s address	1222 ORANGE AVE STE B, WINTER PARK, FL, 327894918

Signature of

Role	Plan administrator
Date	2015-04-27
Name of individual signing	NANCY SMITH
Valid signature	Filed with authorized/valid electronic signature

File	View Page
Three-digit plan number (PN)	002
Effective date of plan	2008-01-01
Business code	453990
Sponsor’s telephone number	4077407772
Plan sponsor’s address	1222 ORANGE AVE STE B, WINTER PARK, FL, 327894918

Signature of

Role	Plan administrator
Date	2014-07-08
Name of individual signing	NANCY SMITH
Valid signature	Filed with authorized/valid electronic signature

File	View Page
Three-digit plan number (PN)	002
Effective date of plan	2008-01-01
Business code	453990
Sponsor’s telephone number	4077407772
Plan sponsor’s address	1222 ORANGE AVE STE B, WINTER PARK, FL, 327894918

Signature of

Role	Plan administrator
Date	2013-06-10
Name of individual signing	SPECIALTY BRACE LIMB INC
Valid signature	Filed with authorized/valid electronic signature