Healthcare Provider Details

I. General information

NPI: 1316093388
Provider Name (Legal Business Name): SPEARS PROSTHETICS AND ORTHOTICS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/25/2007
Last Update Date: 07/12/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

722 N WHITE STATION RD
MEMPHIS TN
38122-4422
US

IV. Provider business mailing address

722 N WHITE STATION RD
MEMPHIS TN
38122-4422
US

V. Phone/Fax

Practice location:
  • Phone: 901-763-6999
  • Fax: 901-682-9062
Mailing address:
  • Phone: 901-763-6999
  • Fax: 901-682-9062

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. MICAH B SPEARS
Title or Position: PRESIDENT
Credential: CPO
Phone: 901-763-6999