Provider Demographics
NPI:1851499628
Name:REYNOLDS PROSTHETICS & ORTHOTICS INC
Entity Type:Organization
Organization Name:REYNOLDS PROSTHETICS & ORTHOTICS INC
Other - Org Name:RPO INC
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:H
Authorized Official - Last Name:REYNOLDS
Authorized Official - Suffix:
Authorized Official - Credentials:CPO
Authorized Official - Phone:865-980-9600
Mailing Address - Street 1:268 CHEROKEE PROFESSIONAL PARK
Mailing Address - Street 2:
Mailing Address - City:MARYVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37804
Mailing Address - Country:US
Mailing Address - Phone:865-980-9600
Mailing Address - Fax:865-980-9603
Practice Address - Street 1:268 CHEROKEE PROFESSIONAL PARK
Practice Address - Street 2:
Practice Address - City:MARYVILLE
Practice Address - State:TN
Practice Address - Zip Code:37804
Practice Address - Country:US
Practice Address - Phone:865-980-9600
Practice Address - Fax:865-980-9603
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2007-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN4022662OtherBLUE CROSS BLUE SHIELD TN
TN1454185Medicaid
TN4022662OtherBLUE CROSS BLUE SHIELD TN