MEDICARE: CRANIAL PROSTHESIS OF MEMPHIS

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

General Provider Information

NPI Number	:	1467309872
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CRANIAL PROSTHESIS OF MEMPHIS

Provider Business Mailing Address
First Line	:	3835 BUCKLEY CV
Second Line	:
City	:	BARTLETT
State	:	TN
Zip	:	38133-0911
Country	:	US
Telephone Number	:	901-877-8440
Fax Number	:

Provider Business Practice Location Address
First Line	:	4564 WARDEN RD STE K
Second Line	:
City	:	MEMPHIS
State	:	TN
Zip	:	38122-4120
Country	:	US
Telephone Number	:	901-877-8440
Fax Number	:

Authorized Official
Title or Position	:	CRANIAL PROSTHESIS SPECIALIST
Name	:	KHALILAH ANN COE
Credential	:
Telephone Number	:	901-877-8440

Provider Enumeration Date	:	03/13/2026
Last Update Date	:	03/13/2026

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Directions to “CRANIAL PROSTHESIS OF MEMPHIS ” Practice Location

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