Provider Demographics
NPI:1912046186
Name:CENTRAL FABRICATION, INC.
Entity Type:Organization
Organization Name:CENTRAL FABRICATION, INC.
Other - Org Name:CFI PROSTHETICS-ORTHOTICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:TED
Authorized Official - Last Name:SNELL
Authorized Official - Suffix:
Authorized Official - Credentials:CP
Authorized Official - Phone:901-725-0060
Mailing Address - Street 1:PO BOX 34488
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38184-0488
Mailing Address - Country:US
Mailing Address - Phone:901-725-0060
Mailing Address - Fax:901-725-4270
Practice Address - Street 1:1665 N SHELBY OAKS DR STE 105
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38134-7437
Practice Address - Country:US
Practice Address - Phone:901-725-0060
Practice Address - Fax:901-725-4270
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-05
Last Update Date:2012-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNG 010823117335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR118010716Medicaid
TN3543045Medicaid
MS00049159Medicaid
TN0219000001Medicare NSC
AR118010716Medicaid