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General NPI Number Information
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NPI Number | 1578961264
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Entity Type | Organization
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Legal Business Name | CAPITAL PROSTHETIC & ORTHOTIC CENTER INC OF TENNESSEE
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Dates
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Enumeration Date | 12/11/2014
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Last Update Date | 12/11/2014
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Provider Practice Location Address
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Address Line | 1076 COURIER PL SUITE 501
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City | SMYRNA
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State | TN
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Zip | 37167-7705
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Country | US
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Telephone | 615-534-2454
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Fax | 615-534-2452
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Provider Business Mailing Address
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Address Line | 1076 COURIER PL SUITE 501
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City | SMYRNA
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State | TN
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Zip | 37167-7705
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Country | US
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Telephone | 615-534-2454
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Fax | 615-534-2452
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Authorized Official
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Title or Position | GENERAL MGR/PRESIDENT
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Name | SOFIA GREY
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Credential |
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Telephone | 615-534-2454
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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 | 11,12,80
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License Number State | TN
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