MEDICARE: SPEARS PROSTHETICS AND ORTHOTICS LLC

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	335E00000X	Prosthetic/Orthotic Supplier

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
2	4814620002	OTHER	TN	PTAN

General Provider Information

NPI Number	:	1316093388
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SPEARS PROSTHETICS AND ORTHOTICS LLC

Provider Business Mailing Address
First Line	:	722 N WHITE STATION RD
Second Line	:
City	:	MEMPHIS
State	:	TN
Zip	:	38122-4422
Country	:	US
Telephone Number	:	901-763-6999
Fax Number	:	901-682-9062

Provider Business Practice Location Address
First Line	:	722 N WHITE STATION RD
Second Line	:
City	:	MEMPHIS
State	:	TN
Zip	:	38122-4422
Country	:	US
Telephone Number	:	901-763-6999
Fax Number	:	901-682-9062

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. MICAH B SPEARS
Credential	:	CPO
Telephone Number	:	901-763-6999

Provider Enumeration Date	:	01/25/2007
Last Update Date	:	07/12/2013

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