Provider Demographics
NPI:1376778324
Name:ORTHOMEDIQ HEALTH CARE, LLC
Entity Type:Organization
Organization Name:ORTHOMEDIQ HEALTH CARE, LLC
Other - Org Name:ADVANCED PROSTHETIC SYSTEMS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:N
Authorized Official - Last Name:PITTMAN
Authorized Official - Suffix:
Authorized Official - Credentials:CPO
Authorized Official - Phone:615-364-5802
Mailing Address - Street 1:394 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:HENDERSONVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37075-3348
Mailing Address - Country:US
Mailing Address - Phone:615-822-8850
Mailing Address - Fax:615-824-4641
Practice Address - Street 1:3598 LONE OAK RD
Practice Address - Street 2:
Practice Address - City:PADUCAH
Practice Address - State:KY
Practice Address - Zip Code:42003-5767
Practice Address - Country:US
Practice Address - Phone:270-554-3606
Practice Address - Fax:270-554-3607
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-20
Last Update Date:2009-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier