Provider Demographics
NPI:1710161542
Name:BEI BRUH THA LLC
Entity Type:Organization
Organization Name:BEI BRUH THA LLC
Other - Org Name:FOOT SOLUTIONS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:AURDIE
Authorized Official - Middle Name:
Authorized Official - Last Name:AMOO ASANTE
Authorized Official - Suffix:
Authorized Official - Credentials:PEDORTHIST
Authorized Official - Phone:615-771-7890
Mailing Address - Street 1:2000 MALLORY LN
Mailing Address - Street 2:SUITE 615
Mailing Address - City:FRANKLIN
Mailing Address - State:TN
Mailing Address - Zip Code:37067-8209
Mailing Address - Country:US
Mailing Address - Phone:615-771-7890
Mailing Address - Fax:615-771-7839
Practice Address - Street 1:2000 MALLORY LN
Practice Address - Street 2:SUITE 615
Practice Address - City:FRANKLIN
Practice Address - State:TN
Practice Address - Zip Code:37067-8209
Practice Address - Country:US
Practice Address - Phone:615-771-7890
Practice Address - Fax:615-771-7839
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-28
Last Update Date:2007-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN4662690001Medicare NSC