Healthcare Provider Details

I. General information

NPI: 1972229797
Provider Name (Legal Business Name): BTB ORTHOTIC AND PROSTHETIC SOLUTIONS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/13/2022
Last Update Date: 03/06/2024
Certification Date: 03/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

425 HOSPITAL DR STE 3
COLUMBUS MS
39705-1938
US

IV. Provider business mailing address

121 AUTUMN HLS
TUPELO MS
38801-8027
US

V. Phone/Fax

Practice location:
  • Phone: 662-213-3017
  • Fax:
Mailing address:
  • Phone: 662-213-3617
  • Fax: 662-798-0481

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number State

VIII. Authorized Official

Name: TAYLOR BURKS
Title or Position: CEO
Credential:
Phone: 662-213-3617