Provider Demographics
NPI:1235462391
Name:FIRST STEP PROSTHETICS, LLC
Entity Type:Organization
Organization Name:FIRST STEP PROSTHETICS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JEREMY
Authorized Official - Middle Name:E
Authorized Official - Last Name:HARRIS
Authorized Official - Suffix:
Authorized Official - Credentials:CP
Authorized Official - Phone:270-904-6130
Mailing Address - Street 1:1136 US 31W BYP
Mailing Address - Street 2:
Mailing Address - City:BOWLING GREEN
Mailing Address - State:KY
Mailing Address - Zip Code:42101-2420
Mailing Address - Country:US
Mailing Address - Phone:270-904-6130
Mailing Address - Fax:270-904-6132
Practice Address - Street 1:1136 US 31W BYP
Practice Address - Street 2:
Practice Address - City:BOWLING GREEN
Practice Address - State:KY
Practice Address - Zip Code:42101-2420
Practice Address - Country:US
Practice Address - Phone:270-904-6130
Practice Address - Fax:270-904-6132
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-08
Last Update Date:2021-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNPRO0000000124335E00000X
KY335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100109260Medicaid
KY6312310002Medicare NSC
KY7100109260Medicaid
TN6312310002Medicare NSC