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General NPI Number Information
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NPI Number | 1275531220
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Entity Type | Organization
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Legal Business Name | MEMPHIS ORTHOPAEDIC MEDICAL SUPPLIES,LLC.
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Dates
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Enumeration Date | 07/13/2005
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Last Update Date | 09/11/2025
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Provider Practice Location Address
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Address Line | 2809 KIRBY PARKWAY SUITE 105
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City | MEMPHIS
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State | TN
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Zip | 38119-8241
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Country | US
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Telephone | 901-755-4344
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Fax | 901-755-4099
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Provider Business Mailing Address
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Address Line | 2809 KIRBY PARKWAY SUITE 105
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City | MEMPHIS
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State | TN
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Zip | 38119-8241
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Country | US
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Telephone | 901-755-4344
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Fax | 901-755-4099
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. GUY FRED WALLACE
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Credential | CO
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Telephone | 901-755-4344
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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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Taxonomy #2
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number |
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License Number State | TN
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