Healthcare Provider Details

I. General information

NPI: 1306340476
Provider Name (Legal Business Name): ANDERSON BRACE & LIMB PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/22/2018
Last Update Date: 03/22/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

569 SKYLINE DR STE 201
JACKSON TN
38301-3933
US

IV. Provider business mailing address

300 E PARKVIEW ST
DYERSBURG TN
38024-3110
US

V. Phone/Fax

Practice location:
  • Phone: 731-300-3698
  • Fax: 731-300-0742
Mailing address:
  • Phone: 731-286-6006
  • Fax: 731-286-5570

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number87
License Number StateTN

VIII. Authorized Official

Name: MARK WESLEY ANDERSON
Title or Position: OWNER
Credential: CPO
Phone: 731-286-6006