Provider Demographics
NPI:1710933049
Name:ORTHOWEST, INC
Entity Type:Organization
Organization Name:ORTHOWEST, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:D
Authorized Official - Last Name:GILBREATH
Authorized Official - Suffix:
Authorized Official - Credentials:COP
Authorized Official - Phone:423-698-0184
Mailing Address - Street 1:1809 GUNBARREL RD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37421-7185
Mailing Address - Country:US
Mailing Address - Phone:423-490-0496
Mailing Address - Fax:
Practice Address - Street 1:1809 GUNBARREL RD
Practice Address - Street 2:SUITE 102
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37421-7185
Practice Address - Country:US
Practice Address - Phone:423-490-0496
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SOUTHEASTERN ORTHOTICS & PROSTHETICS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-05-26
Last Update Date:2010-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN5508550001Medicare NSC