Healthcare Provider Details

I. General information

NPI: 1245534585
Provider Name (Legal Business Name): XTREME PROSTHETICS, LLC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/30/2010
Last Update Date: 05/14/2021
Certification Date: 05/14/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1005 WEST COLUMBIA ST SUITE B
SOMERSET KY
42503
US

IV. Provider business mailing address

1005 WEST COLUMBIA ST. SUITE B
SOMERSET KY
42503
US

V. Phone/Fax

Practice location:
  • Phone: 606-451-0668
  • Fax: 606-451-0078
Mailing address:
  • Phone: 606-451-0668
  • Fax: 606-451-0078

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: MR. AARON E KRATOHVIL JR.
Title or Position: VP OF FINANCE, CONTROLLER
Credential: C.P.O.
Phone: 615-550-8760