Healthcare Provider Details

I. General information

NPI: 1225703838
Provider Name (Legal Business Name): XTREME PROSTHETICS, LLC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/16/2021
Last Update Date: 10/05/2021
Certification Date: 10/05/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1320 ANDREA ST STE B
BOWLING GREEN KY
42104-3334
US

IV. Provider business mailing address

102 WOODMONT BLVD STE 400
NASHVILLE TN
37205-5217
US

V. Phone/Fax

Practice location:
  • Phone: 270-721-2009
  • Fax:
Mailing address:
  • Phone: 615-864-8790
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number State

VIII. Authorized Official

Name: AARON KRATOHVIL
Title or Position: VP OF FINANCE, CONTROLLER
Credential:
Phone: 615-550-8760