MEDICARE: MR. MICAH BRITT SPEARS CPO

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	222Z00000X	Orthotist
2	224P00000X	Prosthetist

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	49849	OTHER	AR	BLUE CROSS BLUE SHIELD

General Provider Information

NPI Number	:	1831193283
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. MICAH BRITT SPEARS CPO

Provider Business Mailing Address
First Line	:	5402 BRANTFORD AVE.
Second Line	:
City	:	MEMPHIS
State	:	TN
Zip	:	38120-2440
Country	:	US
Telephone Number	:	901-767-3665
Fax Number	:	501-206-3505

Provider Business Practice Location Address
First Line	:	2000 HWY 25B. N.
Second Line	:	SUITE C-1
City	:	HEBER SPRINGS
State	:	AR
Zip	:	72543
Country	:	US
Telephone Number	:	501-206-3500
Fax Number	:	501-206-3505

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

Provider Enumeration Date	:	06/13/2005
Last Update Date	:	01/04/2008

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