=====================================================
General NPI Number Information
=====================================================
NPI Number | 1336508431
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ULTRAFLEX SYSTEMS, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/17/2016
-----------------------------------------------------
Last Update Date | 02/17/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 200 W. MARTIN LUTHER KING BLVD. SUITE 1000
-----------------------------------------------------
City | CHATTANOOGA
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 37402
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 423-521-2171
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 237 SOUTH ST SUITE 200
-----------------------------------------------------
City | POTTSTOWN
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19464-5984
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | INSURANCE CONTRACTING SPECIALIST
-----------------------------------------------------
Name | BETH WULFERT
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 610-819-6017
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 335E00000X
-----------------------------------------------------
Taxonomy Name | Prosthetic/Orthotic Supplier
-----------------------------------------------------
License Number | 6000004052
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------