MEDICARE: CLARKSVILLE LIMB & BRACE & REHAB., INC.

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	1744P3200X	Prosthetics Case Management

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	000000070507	OTHER	KY	ANTHEM
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1215932801
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CLARKSVILLE LIMB & BRACE & REHAB., INC.

Provider Business Mailing Address
First Line	:	980 PROFESSIONAL PARK DR STE B
Second Line	:
City	:	CLARKSVILLE
State	:	TN
Zip	:	37040-5251
Country	:	US
Telephone Number	:	931-648-2155
Fax Number	:	931-647-4952

Provider Business Practice Location Address
First Line	:	230 S FRANKLIN ST
Second Line	:
City	:	RUSSELLVILLE
State	:	KY
Zip	:	42276-1937
Country	:	US
Telephone Number	:	270-726-1200
Fax Number	:	270-726-8644

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	MS. JUDY LYNN FARRIS
Credential	:
Telephone Number	:	931-648-2155

Provider Enumeration Date	:	06/20/2005
Last Update Date	:	07/07/2021

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