Healthcare Provider Details

I. General information

NPI: 1942271549
Provider Name (Legal Business Name): SMUTHERS PROSTHETICS & ORTHOTICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/31/2006
Last Update Date: 06/23/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

114 BRIDGETON PLZ
BYRAM MS
39272-8710
US

IV. Provider business mailing address

445 BROOKWOOD ESTATES DR
BYRAM MS
39272-5661
US

V. Phone/Fax

Practice location:
  • Phone: 769-251-0555
  • Fax: 769-251-0366
Mailing address:
  • Phone: 769-251-0555
  • Fax: 769-251-0366

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. CALVIN M BERRY SR.
Title or Position: PRESIDENT CEO
Credential: BOCPO CP LPO
Phone: 769-251-0555