MEDICARE: COLUMBUS BRACE AND LIMB, 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	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

General Provider Information

NPI Number	:	1417982976
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COLUMBUS BRACE AND LIMB, INC

Provider Business Mailing Address
First Line	:	2323 5TH ST N
Second Line	:
City	:	COLUMBUS
State	:	MS
Zip	:	39705-2213
Country	:	US
Telephone Number	:	662-328-8084
Fax Number	:	662-328-1060

Provider Business Practice Location Address
First Line	:	2323 5TH ST N
Second Line	:
City	:	COLUMBUS
State	:	MS
Zip	:	39705-2213
Country	:	US
Telephone Number	:	662-328-8084
Fax Number	:	662-328-1060

Authorized Official
Title or Position	:	PRESIDENT
Name	:	ANDREW S KIRBY
Credential	:
Telephone Number	:	662-328-8084

Provider Enumeration Date	:	07/12/2006
Last Update Date	:	08/22/2020

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