Healthcare Provider Details

I. General information

NPI: 1720364722
Provider Name (Legal Business Name): ADVANCED BRACING SOLUTIONS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/23/2011
Last Update Date: 10/23/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3224 DIJON AVE
OCEAN SPRINGS MS
39564-8520
US

IV. Provider business mailing address

3224 DIJON AVE
OCEAN SPRINGS MS
39564-8520
US

V. Phone/Fax

Practice location:
  • Phone: 228-363-0500
  • Fax: 228-207-0520
Mailing address:
  • Phone: 228-363-0500
  • Fax: 228-207-0520

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number StateMS

VIII. Authorized Official

Name: MRS. TAMMY SMITH
Title or Position: OWNER
Credential:
Phone: 228-363-0500