Provider Demographics
NPI:1932104510
Name:CLARKSVILLE LIMB & BRACE & REHAB., INC.
Entity Type:Organization
Organization Name:CLARKSVILLE LIMB & BRACE & REHAB., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER OF BIONIC
Authorized Official - Prefix:
Authorized Official - First Name:SUMESH
Authorized Official - Middle Name:
Authorized Official - Last Name:SAXENA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:219-791-9200
Mailing Address - Street 1:980 PROFESSIONAL PARK DR STE B
Mailing Address - Street 2:
Mailing Address - City:CLARKSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37040-5251
Mailing Address - Country:US
Mailing Address - Phone:931-648-2155
Mailing Address - Fax:931-647-4952
Practice Address - Street 1:980 PROFESSIONAL PARK DR
Practice Address - Street 2:SUITE B
Practice Address - City:CLARKSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37040-4539
Practice Address - Country:US
Practice Address - Phone:931-648-2155
Practice Address - Fax:931-648-9673
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-20
Last Update Date:2022-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
No1744P3200XOther Service ProvidersSpecialistProsthetics Case ManagementGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3563450Medicaid
KY90262569Medicaid
TN000000070505OtherANTHEM
TN0144416OtherBLUECROSS BLUESHEILD
TN3563450Medicaid