Provider Demographics
NPI:1225703838
Name:XTREME PROSTHETICS, LLC.
Entity Type:Organization
Organization Name:XTREME PROSTHETICS, LLC.
Other - Org Name:BULOW ORTHOTIC AND PROSTHETIC SOLUTIONS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP OF FINANCE, CONTROLLER
Authorized Official - Prefix:
Authorized Official - First Name:AARON
Authorized Official - Middle Name:
Authorized Official - Last Name:KRATOHVIL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-550-8760
Mailing Address - Street 1:102 WOODMONT BLVD STE 400
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37205-5217
Mailing Address - Country:US
Mailing Address - Phone:615-864-8790
Mailing Address - Fax:
Practice Address - Street 1:1320 ANDREA ST STE B
Practice Address - Street 2:
Practice Address - City:BOWLING GREEN
Practice Address - State:KY
Practice Address - Zip Code:42104-3334
Practice Address - Country:US
Practice Address - Phone:270-721-2009
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-16
Last Update Date:2021-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier