MEDICARE: ROCKY MOUNTAIN ARTIFICIAL LIMB & BRACE, INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332BC3200X	Customized Equipment (DME)
2	335E00000X	Prosthetic/Orthotic Supplier

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	89748	OTHER	ID	IF BLUE CROSS
3	071705	OTHER	ID	BLUE SHIELD
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	89730	OTHER	ID	POC BLUE CROSS ID#

General Provider Information

NPI Number	:	1265420616
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ROCKY MOUNTAIN ARTIFICIAL LIMB & BRACE, INC

Provider Business Mailing Address
First Line	:	102 WOODMONT BLVD STE 400
Second Line	:
City	:	NASHVILLE
State	:	TN
Zip	:	37205-5217
Country	:	US
Telephone Number	:	615-550-8774
Fax Number	:	615-454-5352

Provider Business Practice Location Address
First Line	:	3746 WOODKING DR
Second Line	:
City	:	IDAHO FALLS
State	:	ID
Zip	:	83404-4720
Country	:	US
Telephone Number	:	208-524-3230
Fax Number	:	208-524-3231

Authorized Official
Title or Position	:	CREDENTIALING MGR.
Name	:	LORI E. MARLER
Credential	:
Telephone Number	:	615-864-8790

Provider Enumeration Date	:	10/10/2005
Last Update Date	:	02/17/2026

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