Healthcare Provider Details

I. General information

NPI: 1407240286
Provider Name (Legal Business Name): BRISTOL ORTHOTICS & PROSTHETICS, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/19/2015
Last Update Date: 03/19/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

445 PORTERFIELD HWY SW SUITE C
ABINGDON VA
24210-2556
US

IV. Provider business mailing address

553 HIGHWAY 126
BRISTOL TN
37620-1685
US

V. Phone/Fax

Practice location:
  • Phone: 276-451-2239
  • Fax: 276-477-5015
Mailing address:
  • Phone: 423-968-4442
  • Fax: 423-968-4777

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: SANDRA NEWPORT
Title or Position: C.O.O.
Credential:
Phone: 423-968-4442