Provider Demographics
NPI:1790387439
Name:FOURROUX PROSTHETICS, INC.
Entity Type:Organization
Organization Name:FOURROUX PROSTHETICS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER / PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:W.
Authorized Official - Middle Name:KEITH
Authorized Official - Last Name:WATSON
Authorized Official - Suffix:
Authorized Official - Credentials:CPO
Authorized Official - Phone:256-534-8672
Mailing Address - Street 1:2743 BOB WALLACE AVE SW
Mailing Address - Street 2:
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35805-4103
Mailing Address - Country:US
Mailing Address - Phone:256-534-8672
Mailing Address - Fax:800-963-5010
Practice Address - Street 1:6706 N 9TH AVE STE E2
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32504-7398
Practice Address - Country:US
Practice Address - Phone:850-741-4340
Practice Address - Fax:800-963-5010
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-09
Last Update Date:2020-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier