Provider Demographics
NPI:1578961264
Name:CAPITAL PROSTHETIC & ORTHOTIC CENTER INC OF TENNESSEE
Entity Type:Organization
Organization Name:CAPITAL PROSTHETIC & ORTHOTIC CENTER INC OF TENNESSEE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL MGR/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SOFIA
Authorized Official - Middle Name:
Authorized Official - Last Name:GREY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-534-2454
Mailing Address - Street 1:1076 COURIER PL
Mailing Address - Street 2:SUITE 501
Mailing Address - City:SMYRNA
Mailing Address - State:TN
Mailing Address - Zip Code:37167-7705
Mailing Address - Country:US
Mailing Address - Phone:615-534-2454
Mailing Address - Fax:615-534-2452
Practice Address - Street 1:1076 COURIER PL
Practice Address - Street 2:SUITE 501
Practice Address - City:SMYRNA
Practice Address - State:TN
Practice Address - Zip Code:37167-7705
Practice Address - Country:US
Practice Address - Phone:615-534-2454
Practice Address - Fax:615-534-2452
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-11
Last Update Date:2014-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN11,12,80335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier