Provider Demographics
NPI:1578212098
Name:CLARKSVILLE LIMB & BRACE & REHAB., INC.
Entity Type:Organization
Organization Name:CLARKSVILLE LIMB & BRACE & REHAB., INC.
Other - Org Name:KENTUCKY PROSTHETICS & ORTHOTICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SUMESH
Authorized Official - Middle Name:
Authorized Official - Last Name:SAXENA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:219-791-9200
Mailing Address - Street 1:3803 E LINCOLN HWY
Mailing Address - Street 2:
Mailing Address - City:MERRILLVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46410-5809
Mailing Address - Country:US
Mailing Address - Phone:219-840-5595
Mailing Address - Fax:
Practice Address - Street 1:1169 EASTERN PKWY STE 4423
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40217-1429
Practice Address - Country:US
Practice Address - Phone:502-585-4228
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BIONIC PROSTHETICS AND ORTHOTICS GROUP LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-03-22
Last Update Date:2022-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
No1744P3200XOther Service ProvidersSpecialistProsthetics Case ManagementGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
0127980006OtherNSC