Provider Demographics
NPI:1710157466
Name:JOHN REYNOLDS O&P, LLC
Entity Type:Organization
Organization Name:JOHN REYNOLDS O&P, LLC
Other - Org Name:RPO, LLC - OAK RIDGE
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:CLINT
Authorized Official - Middle Name:
Authorized Official - Last Name:MCKINLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:859-260-8576
Mailing Address - Street 1:354 WALLER AVE
Mailing Address - Street 2:SUITE 150
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40504-2928
Mailing Address - Country:US
Mailing Address - Phone:859-260-8576
Mailing Address - Fax:859-260-1380
Practice Address - Street 1:1062 OAK RIDGE TPKE
Practice Address - Street 2:SUITE B
Practice Address - City:OAK RIDGE
Practice Address - State:TN
Practice Address - Zip Code:37830-6479
Practice Address - Country:US
Practice Address - Phone:865-483-8787
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:JOHN REYNOLDS O&P, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-03-10
Last Update Date:2008-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier