Provider Demographics
NPI:1144406257
Name:CLOVIS BRACE SHOP
Entity Type:Organization
Organization Name:CLOVIS BRACE SHOP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER/CUSTOMER SERVICE
Authorized Official - Prefix:MS
Authorized Official - First Name:CINDA
Authorized Official - Middle Name:J
Authorized Official - Last Name:BARRINGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:575-762-3524
Mailing Address - Street 1:128 W 21ST ST
Mailing Address - Street 2:
Mailing Address - City:CLOVIS
Mailing Address - State:NM
Mailing Address - Zip Code:88101-4333
Mailing Address - Country:US
Mailing Address - Phone:575-762-3524
Mailing Address - Fax:575-762-3523
Practice Address - Street 1:128 W 21ST ST
Practice Address - Street 2:
Practice Address - City:CLOVIS
Practice Address - State:NM
Practice Address - Zip Code:88101-4333
Practice Address - Country:US
Practice Address - Phone:575-762-3524
Practice Address - Fax:575-762-3523
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-18
Last Update Date:2008-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM76877329Medicaid
NMNM00TB32OtherBLUE CROSS BLUE SHIELD
NM76877329Medicaid