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General NPI Number Information
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NPI Number | 1063179497
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Entity Type | Organization
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Legal Business Name | XTREME PROSTHETICS, LLC.
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Dates
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Enumeration Date | 11/19/2021
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Last Update Date | 11/19/2021
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Provider Practice Location Address
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Address Line | 4122 SHELBYVILLE RD STE 108
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City | LOUISVILLE
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State | KY
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Zip | 40207-3206
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Country | US
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Telephone | 503-308-4144
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Fax |
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Provider Business Mailing Address
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Address Line | 102 WOODMONT BLVD STE 120
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City | NASHVILLE
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State | TN
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Zip | 37205-5249
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Country | US
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Telephone | 161-586-4879
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Fax |
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Authorized Official
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Title or Position | VP OF FINANCE, CONTROLLER
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Name | AARON KRATOHVIL
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Credential |
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Telephone | 615-550-8760
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 335E00000X
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Taxonomy Name | Prosthetic/Orthotic Supplier
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License Number |
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License Number State |
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