Provider Demographics
NPI:1790787083
Name:PRECISION PROSTHETICS, INC.
Entity Type:Organization
Organization Name:PRECISION PROSTHETICS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:BONNI
Authorized Official - Middle Name:
Authorized Official - Last Name:WILKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:901-682-1006
Mailing Address - Street 1:1505 S PERKINS RD
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38117-6530
Mailing Address - Country:US
Mailing Address - Phone:901-682-1006
Mailing Address - Fax:901-682-5775
Practice Address - Street 1:1505 S PERKINS RD
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38117-6530
Practice Address - Country:US
Practice Address - Phone:901-682-1006
Practice Address - Fax:901-682-5775
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-01
Last Update Date:2013-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN81650OtherNORTHWOOD/ NPN
TN0112460OtherBCBS OF TN
TN3556346Medicaid
TN3556346Medicaid