MEDICARE: ERIC D KIMSEY BOCP/L

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

General Provider Information

NPI Number	:	1679743140
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ERIC D KIMSEY BOCP/L

Provider Business Mailing Address
First Line	:	1050 WILLOW CIR
Second Line	:
City	:	CLARKSVILLE
State	:	TN
Zip	:	37043-6854
Country	:	US
Telephone Number	:	931-552-5898
Fax Number	:

Provider Business Practice Location Address
First Line	:	1823 CHARLOTTE AVE
Second Line	:
City	:	NASHVILLE
State	:	TN
Zip	:	37203-2104
Country	:	US
Telephone Number	:	615-340-0068
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/11/2008
Last Update Date	:	07/10/2013

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