Provider Demographics
NPI:1508941220
Name:J. J. HILL BRACE AND LIMB CO., INC.
Entity Type:Organization
Organization Name:J. J. HILL BRACE AND LIMB CO., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:LAWRENCE
Authorized Official - Middle Name:ALLEN
Authorized Official - Last Name:HILL
Authorized Official - Suffix:
Authorized Official - Credentials:CP, BOCOP, C PED
Authorized Official - Phone:228-863-0381
Mailing Address - Street 1:1619 BROAD AVE
Mailing Address - Street 2:
Mailing Address - City:GULFPORT
Mailing Address - State:MS
Mailing Address - Zip Code:39501-3604
Mailing Address - Country:US
Mailing Address - Phone:228-863-0381
Mailing Address - Fax:228-863-2784
Practice Address - Street 1:1619 BROAD AVE
Practice Address - Street 2:
Practice Address - City:GULFPORT
Practice Address - State:MS
Practice Address - Zip Code:39501-3604
Practice Address - Country:US
Practice Address - Phone:228-863-0381
Practice Address - Fax:228-863-2784
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-25
Last Update Date:2010-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS000011708OtherBLUE CROSS BLUE SHIELD
MS00040510Medicaid
MS16865400OtherUS DEPARTMENT OF LABOR
MS000011708OtherBLUE CROSS BLUE SHIELD
MS00040510Medicaid
MS16865400OtherUS DEPARTMENT OF LABOR