Provider Demographics
NPI:1700014735
Name:SUPERIOR ORTHOTICS & PROSTHETICS, LLC
Entity Type:Organization
Organization Name:SUPERIOR ORTHOTICS & PROSTHETICS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:N
Authorized Official - Last Name:PITTMAN
Authorized Official - Suffix:
Authorized Official - Credentials:CPO
Authorized Official - Phone:615-364-5802
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:615-340-0068
Mailing Address - Fax:615-340-0028
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:615-340-0068
Practice Address - Fax:615-340-0028
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SUPERIOR O & P, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-06-29
Last Update Date:2011-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN6189890003Medicare NSC