MEDICARE: IN MOTION ORTHOTICS, 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

General Provider Information

NPI Number	:	1801175583
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	IN MOTION ORTHOTICS, LLC

Provider Business Mailing Address
First Line	:	224 MEADOWLANE ST
Second Line	:
City	:	EUPORA
State	:	MS
Zip	:	39744-2219
Country	:	US
Telephone Number	:	662-258-8201
Fax Number	:	662-258-8202

Provider Business Practice Location Address
First Line	:	224 MEADOWLANE ST
Second Line	:
City	:	EUPORA
State	:	MS
Zip	:	39744-2219
Country	:	US
Telephone Number	:	662-258-8201
Fax Number	:	662-258-8202

Authorized Official
Title or Position	:	OWNER
Name	:	MR. JOEY LEON CARNEY
Credential	:	BOCO
Telephone Number	:	662-258-8201

Provider Enumeration Date	:	08/11/2011
Last Update Date	:	08/11/2011

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