Healthcare Provider Details

I. General information

NPI: 1225403942
Provider Name (Legal Business Name): CENTER FOR ORTHOTICS AND PROSTHETICS INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/07/2015
Last Update Date: 08/31/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2321 5TH ST N
COLUMBUS MS
39705-2213
US

IV. Provider business mailing address

6655 QUINCE RD STE 124
MEMPHIS TN
38119-8031
US

V. Phone/Fax

Practice location:
  • Phone: 662-243-7435
  • Fax:
Mailing address:
  • Phone: 901-757-5461
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number State

VIII. Authorized Official

Name: JACK R STEELE
Title or Position: PRESIDENT
Credential:
Phone: 901-757-5461