Provider Demographics
NPI:1497930226
Name:BLUFF PROSTHETICS AND ORTHOTICS LLC
Entity Type:Organization
Organization Name:BLUFF PROSTHETICS AND ORTHOTICS LLC
Other - Org Name:SEMO PROSTHETICS & ORTHOTICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:HORACE
Authorized Official - Middle Name:
Authorized Official - Last Name:HODGES
Authorized Official - Suffix:
Authorized Official - Credentials:CP
Authorized Official - Phone:573-778-3700
Mailing Address - Street 1:915 W PINE ST
Mailing Address - Street 2:
Mailing Address - City:POPLAR BLUFF
Mailing Address - State:MO
Mailing Address - Zip Code:63901-4969
Mailing Address - Country:US
Mailing Address - Phone:573-778-3700
Mailing Address - Fax:573-778-3702
Practice Address - Street 1:915 W PINE ST
Practice Address - Street 2:
Practice Address - City:POPLAR BLUFF
Practice Address - State:MO
Practice Address - Zip Code:63901-4969
Practice Address - Country:US
Practice Address - Phone:573-778-3700
Practice Address - Fax:573-778-3702
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-28
Last Update Date:2021-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO6050540001Medicare NSC