MEDICARE: XTREME PROSTHETICS LLC.

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	135770	KY

General Provider Information

NPI Number	:	1992249718
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	XTREME PROSTHETICS LLC.

Provider Business Mailing Address
First Line	:	102 WOODMONT BLVD STE 400
Second Line	:
City	:	NASHVILLE
State	:	TN
Zip	:	37205-5217
Country	:	US
Telephone Number	:	615-550-8774
Fax Number	:

Provider Business Practice Location Address
First Line	:	400 S BROADWAY ST
Second Line	:
City	:	GLASGOW
State	:	KY
Zip	:	42141-2502
Country	:	US
Telephone Number	:	270-629-5462
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR
Name	:	BRADFORD NEIL GARDNER
Credential	:
Telephone Number	:	615-864-8783

Provider Enumeration Date	:	12/13/2016
Last Update Date	:	05/29/2026

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