Provider Demographics
NPI:1700226016
Name:LOWRY MEDICAL SUPPLY
Entity Type:Organization
Organization Name:LOWRY MEDICAL SUPPLY
Other - Org Name:ORTHOTIC SOLUTIONS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:
Authorized Official - Last Name:LOWRY
Authorized Official - Suffix:
Authorized Official - Credentials:CFO
Authorized Official - Phone:615-331-0036
Mailing Address - Street 1:PO BOX 2412
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:TN
Mailing Address - Zip Code:37024-2412
Mailing Address - Country:US
Mailing Address - Phone:615-331-0036
Mailing Address - Fax:615-833-3869
Practice Address - Street 1:203 E GRUNDY ST
Practice Address - Street 2:
Practice Address - City:TULLAHOMA
Practice Address - State:TN
Practice Address - Zip Code:37388-3621
Practice Address - Country:US
Practice Address - Phone:615-876-6606
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-01
Last Update Date:2013-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN135100332B00000X, 335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
166393600OtherDEPARTMENT OF LABOR
TN3562020Medicaid
TN4112378OtherBLUE CROSS BLUE SHIELD
4112378OtherTENNCARE SELECT
TN4112378OtherBLUE CROSS BLUE SHIELD