Provider Demographics
NPI:1437497377
Name:WOLFCHASE LIMB & BRACE
Entity Type:Organization
Organization Name:WOLFCHASE LIMB & BRACE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LARRY
Authorized Official - Middle Name:J
Authorized Official - Last Name:BUTLER
Authorized Official - Suffix:
Authorized Official - Credentials:CPO
Authorized Official - Phone:901-507-7821
Mailing Address - Street 1:7625 US HIGHWAY 64
Mailing Address - Street 2:SUITE 103
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38133-4066
Mailing Address - Country:US
Mailing Address - Phone:901-507-7821
Mailing Address - Fax:901-507-7824
Practice Address - Street 1:367 VANN DR
Practice Address - Street 2:SUITE B
Practice Address - City:JACKSON
Practice Address - State:TN
Practice Address - Zip Code:38305-6038
Practice Address - Country:US
Practice Address - Phone:731-660-5900
Practice Address - Fax:731-660-5050
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WOLFCHASE LIMB & BRACE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-01-28
Last Update Date:2023-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNCO003654335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier