Provider Demographics
NPI:1093150575
Name:ORTHOPEDIC BRACES
Entity Type:Organization
Organization Name:ORTHOPEDIC BRACES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ORTHOTIST/PROSTHETIST OWNER
Authorized Official - Prefix:
Authorized Official - First Name:EDWIN
Authorized Official - Middle Name:
Authorized Official - Last Name:DOWNS
Authorized Official - Suffix:
Authorized Official - Credentials:CO
Authorized Official - Phone:931-563-7142
Mailing Address - Street 1:206 WESTSIDE DR
Mailing Address - Street 2:
Mailing Address - City:TULLAHOMA
Mailing Address - State:TN
Mailing Address - Zip Code:37388-3255
Mailing Address - Country:US
Mailing Address - Phone:931-563-7142
Mailing Address - Fax:931-563-7142
Practice Address - Street 1:206 WESTSIDE DR
Practice Address - Street 2:
Practice Address - City:TULLAHOMA
Practice Address - State:TN
Practice Address - Zip Code:37388
Practice Address - Country:US
Practice Address - Phone:931-563-7142
Practice Address - Fax:931-563-7142
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-09
Last Update Date:2013-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNORT0000000208251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC0677570001Medicare NSC