Provider Demographics
NPI:1164161444
Name:FILLAUER ORTHOTICS AND PROSTHETICS, INC.
Entity Type:Organization
Organization Name:FILLAUER ORTHOTICS AND PROSTHETICS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:THEODORE
Authorized Official - Middle Name:
Authorized Official - Last Name:MACDONALD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-214-3777
Mailing Address - Street 1:820 FESSLERS PKWY STE 310
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37210-2938
Mailing Address - Country:US
Mailing Address - Phone:615-214-3777
Mailing Address - Fax:
Practice Address - Street 1:2515 LIFESTYLE WAY STE 101
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37421-1985
Practice Address - Country:US
Practice Address - Phone:615-214-3777
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-03
Last Update Date:2022-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier