Provider Demographics
NPI:1144210600
Name:TENNESSEE BRACE AND MEDICAL SERVICES LLC
Entity Type:Organization
Organization Name:TENNESSEE BRACE AND MEDICAL SERVICES LLC
Other - Org Name:TENNESSEE BRACE AND MEDICAL SERVICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF OPERATION
Authorized Official - Prefix:MRS
Authorized Official - First Name:CHRISTY
Authorized Official - Middle Name:JO
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:931-438-2777
Mailing Address - Street 1:118 SHELBYVILLE HWY
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37334-7128
Mailing Address - Country:US
Mailing Address - Phone:931-438-2777
Mailing Address - Fax:931-438-2778
Practice Address - Street 1:118 SHELBYVILLE HWY
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:TN
Practice Address - Zip Code:37334-7128
Practice Address - Country:US
Practice Address - Phone:931-438-2777
Practice Address - Fax:931-438-2778
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-26
Last Update Date:2016-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000000652332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3163024OtherBCBS OF TENNESSEE/TENNCAR
TN1454107Medicaid
TN1454107Medicaid