MEDICARE: B.A. KNOTT PROSTHETICS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332B00000X	Durable Medical Equipment & Medical Supplies		VA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1114073905
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	B.A. KNOTT PROSTHETICS

Provider Business Mailing Address
First Line	:	4912 W MARSHALL ST
Second Line	:	SUITE 101
City	:	RICHMOND
State	:	VA
Zip	:	23230-3127
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4912 W MARSHALL ST
Second Line	:	SUITE 101
City	:	RICHMOND
State	:	VA
Zip	:	23230-3127
Country	:	US
Telephone Number	:	804-355-4773
Fax Number	:

Authorized Official
Title or Position	:	BILLING MANAGER
Name	:	STEVEN F SHIELDS
Credential	:
Telephone Number	:	804-282-9133

Provider Enumeration Date	:	01/26/2007
Last Update Date	:	03/05/2008

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