Provider Demographics
NPI:1568473999
Name:PUTNAM COUNTY ORTHOPEDIC APPLIANCE CO., INC.
Entity Type:Organization
Organization Name:PUTNAM COUNTY ORTHOPEDIC APPLIANCE CO., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:BARRY
Authorized Official - Middle Name:K
Authorized Official - Last Name:CANTER
Authorized Official - Suffix:
Authorized Official - Credentials:CPO, LPO
Authorized Official - Phone:615-327-2505
Mailing Address - Street 1:1807 CHURCH ST
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37203-2201
Mailing Address - Country:US
Mailing Address - Phone:615-327-2505
Mailing Address - Fax:615-327-2506
Practice Address - Street 1:1700 WEST AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:CROSSVILLE
Practice Address - State:TN
Practice Address - Zip Code:38555-6090
Practice Address - Country:US
Practice Address - Phone:931-707-1254
Practice Address - Fax:615-327-2506
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-10
Last Update Date:2014-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN0212220002Medicare NSC