Healthcare Provider Details

I. General information

NPI: 1417982976
Provider Name (Legal Business Name): COLUMBUS BRACE AND LIMB, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/12/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2323 5TH ST N
COLUMBUS MS
39705-2213
US

IV. Provider business mailing address

2323 5TH ST N
COLUMBUS MS
39705-2213
US

V. Phone/Fax

Practice location:
  • Phone: 662-328-8084
  • Fax: 662-328-1060
Mailing address:
  • Phone: 662-328-8084
  • Fax: 662-328-1060

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: ANDREW S KIRBY
Title or Position: PRESIDENT
Credential:
Phone: 662-328-8084