Provider Demographics
NPI:1851837686
Name:JERALD C GIFFORD
Entity Type:Organization
Organization Name:JERALD C GIFFORD
Other - Org Name:MIDDLE TENNESSEE O&P
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JERALD
Authorized Official - Middle Name:CRAIG
Authorized Official - Last Name:GIFFORD
Authorized Official - Suffix:
Authorized Official - Credentials:CPO, LPO
Authorized Official - Phone:615-809-2650
Mailing Address - Street 1:1411 MARK ALLEN LN STE C
Mailing Address - Street 2:
Mailing Address - City:MURFREESBORO
Mailing Address - State:TN
Mailing Address - Zip Code:37129-5556
Mailing Address - Country:US
Mailing Address - Phone:615-809-2650
Mailing Address - Fax:615-410-7392
Practice Address - Street 1:1411 MARK ALLEN LN STE C
Practice Address - Street 2:
Practice Address - City:MURFREESBORO
Practice Address - State:TN
Practice Address - Zip Code:37129-5556
Practice Address - Country:US
Practice Address - Phone:615-809-2650
Practice Address - Fax:615-410-7392
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-18
Last Update Date:2020-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNPRO77, ORT99335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ035307Medicaid