Provider Demographics
NPI:1508930769
Name:ROBERT N PITTMAN
Entity Type:Organization
Organization Name:ROBERT N PITTMAN
Other - Org Name:SUPERIOR ORTHOTICS & PROSTHETICS, LLC
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ROB
Authorized Official - Middle Name:NEWELL
Authorized Official - Last Name:PITTMAN
Authorized Official - Suffix:
Authorized Official - Credentials:CPO
Authorized Official - Phone:615-340-0068
Mailing Address - Street 1:1823 CHARLOTTE AVE
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37203-2104
Mailing Address - Country:US
Mailing Address - Phone:615-306-1021
Mailing Address - Fax:
Practice Address - Street 1:1823 CHARLOTTE AVE
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37203-2104
Practice Address - Country:US
Practice Address - Phone:615-306-1021
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-20
Last Update Date:2013-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNPRO064335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1053578153Medicare NSC