Healthcare Provider Details

I. General information

NPI: 1144210600
Provider Name (Legal Business Name): TENNESSEE BRACE AND MEDICAL SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/26/2005
Last Update Date: 12/29/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

118 SHELBYVILLE HWY
FAYETTEVILLE TN
37334-7128
US

IV. Provider business mailing address

118 SHELBYVILLE HWY
FAYETTEVILLE TN
37334-7128
US

V. Phone/Fax

Practice location:
  • Phone: 931-438-2777
  • Fax: 931-438-2778
Mailing address:
  • Phone: 931-438-2777
  • Fax: 931-438-2778

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number0000000652
License Number StateTN

VIII. Authorized Official

Name: MRS. CHRISTY JO BROWN
Title or Position: DIRECTOR OF OPERATION
Credential:
Phone: 931-438-2777