Healthcare Provider Details

I. General information

NPI: 1275531220
Provider Name (Legal Business Name): MEMPHIS ORTHOPAEDIC MEDICAL SUPPLIES,LLC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/13/2005
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2809 KIRBY PARKWAY SUITE 105
MEMPHIS TN
38119-8241
US

IV. Provider business mailing address

2809 KIRBY PARKWAY SUITE 105
MEMPHIS TN
38119-8241
US

V. Phone/Fax

Practice location:
  • Phone: 901-755-4344
  • Fax: 901-755-4099
Mailing address:
  • Phone: 901-755-4344
  • Fax: 901-755-4099

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number StateTN

VIII. Authorized Official

Name: MR. GUY FRED WALLACE
Title or Position: PRESIDENT
Credential: CO
Phone: 901-755-4344