Healthcare Provider Details

I. General information

NPI: 1568473999
Provider Name (Legal Business Name): PUTNAM COUNTY ORTHOPEDIC APPLIANCE CO., INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/10/2006
Last Update Date: 09/15/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1700 WEST AVE SUITE 101
CROSSVILLE TN
38555-6090
US

IV. Provider business mailing address

1807 CHURCH ST
NASHVILLE TN
37203-2201
US

V. Phone/Fax

Practice location:
  • Phone: 931-707-1254
  • Fax: 615-327-2506
Mailing address:
  • Phone: 615-327-2505
  • Fax: 615-327-2506

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: MR. BARRY K CANTER
Title or Position: OWNER
Credential: CPO, LPO
Phone: 615-327-2505