=====================================================
General NPI Number Information
=====================================================
NPI Number | 1144244633
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | FITTING CONCEPTS INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/27/2006
-----------------------------------------------------
Last Update Date | 10/05/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 130 S INDUSTRIAL RD
-----------------------------------------------------
City | TUPELO
-----------------------------------------------------
State | MS
-----------------------------------------------------
Zip | 38801-4614
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 662-841-2476
-----------------------------------------------------
Fax | 662-841-2476
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 130 S INDUSTRIAL RD
-----------------------------------------------------
City | TUPELO
-----------------------------------------------------
State | MS
-----------------------------------------------------
Zip | 38801-4618
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 662-841-2476
-----------------------------------------------------
Fax | 662-841-2476
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | MRS. AMANDA LASHEA WHITE
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 662-841-2476
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 335E00000X
-----------------------------------------------------
Taxonomy Name | Prosthetic/Orthotic Supplier
-----------------------------------------------------
License Number | 041163411
-----------------------------------------------------
License Number State | MS
-----------------------------------------------------