Healthcare Provider Details

I. General information

NPI: 1386082030
Provider Name (Legal Business Name): BICKERTS ORTHOTICS & PROSTHETICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/04/2013
Last Update Date: 04/03/2026
Certification Date: 04/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2106 S TATE ST
CORINTH MS
38834-7913
US

IV. Provider business mailing address

PO BOX 650846
DALLAS TX
75265-0846
US

V. Phone/Fax

Practice location:
  • Phone: 662-795-4555
  • Fax: 662-643-4131
Mailing address:
  • Phone: 662-795-4555
  • Fax: 662-643-4131

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: JENNIFER L SIMMONS
Title or Position: REGULATORY COMPLIANCE ANALYST III
Credential:
Phone: 206-414-2907