Provider Demographics
NPI:1437641313
Name:TIFFANY R SMITH
Entity Type:Organization
Organization Name:TIFFANY R SMITH
Other - Org Name:TRS PROSTHETICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CRANIAL PROSTHESIS
Authorized Official - Prefix:
Authorized Official - First Name:TIFFANY
Authorized Official - Middle Name:R
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:901-254-2278
Mailing Address - Street 1:469 J E CLARK CV
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:AR
Mailing Address - Zip Code:72364-2308
Mailing Address - Country:US
Mailing Address - Phone:901-254-2278
Mailing Address - Fax:
Practice Address - Street 1:823 EXOCET DR
Practice Address - Street 2:
Practice Address - City:CORDOVA
Practice Address - State:TN
Practice Address - Zip Code:38018-2270
Practice Address - Country:US
Practice Address - Phone:901-254-2278
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-06-05
Last Update Date:2018-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN179792332BC3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment