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General NPI Number Information
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NPI Number | 1245534585
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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 | 12/30/2010
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Last Update Date | 05/14/2021
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Provider Practice Location Address
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Address Line | 1005 WEST COLUMBIA ST SUITE B
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City | SOMERSET
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State | KY
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Zip | 42503
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Country | US
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Telephone | 606-451-0668
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Fax | 606-451-0078
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Provider Business Mailing Address
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Address Line | 1005 WEST COLUMBIA ST. SUITE B
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City | SOMERSET
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State | KY
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Zip | 42503
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Country | US
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Telephone | 606-451-0668
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Fax | 606-451-0078
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Authorized Official
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Title or Position | VP OF FINANCE, CONTROLLER
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Name | MR. AARON E KRATOHVIL JR.
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Credential | C.P.O.
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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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