MEDICARE: SUPERIOR ORTHOTICS & PROSTHETICS, LLC

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	335E00000X	Prosthetic/Orthotic Supplier		TN

General Provider Information

NPI Number	:	1700014735
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SUPERIOR ORTHOTICS & PROSTHETICS, LLC

Provider Business Mailing Address
First Line	:	1823 CHARLOTTE AVE
Second Line	:
City	:	NASHVILLE
State	:	TN
Zip	:	37203-2104
Country	:	US
Telephone Number	:	615-340-0068
Fax Number	:	615-340-0028

Provider Business Practice Location Address
First Line	:	1823 CHARLOTTE AVE
Second Line	:
City	:	NASHVILLE
State	:	TN
Zip	:	37203-2104
Country	:	US
Telephone Number	:	615-340-0068
Fax Number	:	615-340-0028

Authorized Official
Title or Position	:	PRESIDENT
Name	:	ROBERT N PITTMAN
Credential	:	CPO
Telephone Number	:	615-364-5802

Provider Enumeration Date	:	06/29/2009
Last Update Date	:	01/12/2011

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