MEDICARE: HAL MEDICAL O&P TENNESSEE, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	224P00000X	Prosthetist
2	332B00000X	Durable Medical Equipment & Medical Supplies
3	335E00000X	Prosthetic/Orthotic Supplier

General Provider Information

NPI Number	:	1730678590
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HAL MEDICAL O&P TENNESSEE, LLC

Provider Business Mailing Address
First Line	:	117 W MADISON ST
Second Line	:
City	:	PULASKI
State	:	TN
Zip	:	38478-3231
Country	:	US
Telephone Number	:	866-284-8872
Fax Number	:	866-979-1771

Provider Business Practice Location Address
First Line	:	117 W MADISON ST
Second Line	:
City	:	PULASKI
State	:	TN
Zip	:	38478-3231
Country	:	US
Telephone Number	:	866-284-8872
Fax Number	:	866-979-1771

Authorized Official
Title or Position	:	OWNER
Name	:	MR. JOHN D WORLEY
Credential	:
Telephone Number	:	866-284-8872

Provider Enumeration Date	:	05/08/2018
Last Update Date	:	12/06/2022

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