Provider Demographics
NPI:1033132378
Name:BRISTOL ORTHOTICS & PROSTHETICS INC.
Entity Type:Organization
Organization Name:BRISTOL ORTHOTICS & PROSTHETICS INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSHUA
Authorized Official - Middle Name:C
Authorized Official - Last Name:GRAYBEAL
Authorized Official - Suffix:
Authorized Official - Credentials:CP
Authorized Official - Phone:423-968-4442
Mailing Address - Street 1:553 HIGHWAY 126
Mailing Address - Street 2:
Mailing Address - City:BRISTOL
Mailing Address - State:TN
Mailing Address - Zip Code:37620-1685
Mailing Address - Country:US
Mailing Address - Phone:423-968-4442
Mailing Address - Fax:423-968-4777
Practice Address - Street 1:553 HIGHWAY 126
Practice Address - Street 2:
Practice Address - City:BRISTOL
Practice Address - State:TN
Practice Address - Zip Code:37620-1685
Practice Address - Country:US
Practice Address - Phone:423-968-4442
Practice Address - Fax:423-968-4777
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-26
Last Update Date:2009-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA009190881Medicaid
VA009113827Medicaid
TN100025761OtherCARITTEN
VA141558OtherANTHEM
TN3539103Medicaid
TN0009791OtherBLUE CROSS BLUE SHIELD
TN1131621OtherUNITED MINE WORKERS
VA141558OtherANTHEM
TN=========OtherJOHN DEERE HEALTHCARE