MEDICARE: CENTRAL FABRICATION, 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	335E00000X	Prosthetic/Orthotic Supplier	G 010823117	TN

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	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1912046186
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CENTRAL FABRICATION, INC.

Provider Business Mailing Address
First Line	:	PO BOX 34488
Second Line	:
City	:	MEMPHIS
State	:	TN
Zip	:	38184-0488
Country	:	US
Telephone Number	:	901-725-0060
Fax Number	:	901-725-4270

Provider Business Practice Location Address
First Line	:	1665 N SHELBY OAKS DR STE 105
Second Line	:
City	:	MEMPHIS
State	:	TN
Zip	:	38134-7437
Country	:	US
Telephone Number	:	901-725-0060
Fax Number	:	901-725-4270

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. RONALD TED SNELL
Credential	:	CP
Telephone Number	:	901-725-0060

Provider Enumeration Date	:	02/05/2007
Last Update Date	:	01/25/2012

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