Provider Demographics
NPI:1417982976
Name:COLUMBUS BRACE AND LIMB, INC
Entity Type:Organization
Organization Name:COLUMBUS BRACE AND LIMB, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:S
Authorized Official - Last Name:KIRBY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:662-328-8084
Mailing Address - Street 1:2323 5TH ST N
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:MS
Mailing Address - Zip Code:39705-2213
Mailing Address - Country:US
Mailing Address - Phone:662-328-8084
Mailing Address - Fax:662-328-1060
Practice Address - Street 1:2323 5TH ST N
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:MS
Practice Address - Zip Code:39705-2213
Practice Address - Country:US
Practice Address - Phone:662-328-8084
Practice Address - Fax:662-328-1060
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00040210Medicaid