MEDICARE: SMUTHERS PROSTHETICS & ORTHOTICS

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
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1942271549
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SMUTHERS PROSTHETICS & ORTHOTICS

Provider Business Mailing Address
First Line	:	445 BROOKWOOD ESTATES DR
Second Line	:
City	:	BYRAM
State	:	MS
Zip	:	39272-5661
Country	:	US
Telephone Number	:	769-251-0555
Fax Number	:	769-251-0366

Provider Business Practice Location Address
First Line	:	114 BRIDGETON PLZ
Second Line	:
City	:	BYRAM
State	:	MS
Zip	:	39272-8710
Country	:	US
Telephone Number	:	769-251-0555
Fax Number	:	769-251-0366

Authorized Official
Title or Position	:	PRESIDENT CEO
Name	:	MR. CALVIN M BERRY SR.
Credential	:	BOCPO CP LPO
Telephone Number	:	769-251-0555

Provider Enumeration Date	:	01/31/2006
Last Update Date	:	06/23/2016

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Directions to “SMUTHERS PROSTHETICS & ORTHOTICS ” Practice Location

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