Provider Demographics
NPI:1942271549
Name:SMUTHERS PROSTHETICS & ORTHOTICS
Entity Type:Organization
Organization Name:SMUTHERS PROSTHETICS & ORTHOTICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:CALVIN
Authorized Official - Middle Name:M
Authorized Official - Last Name:BERRY
Authorized Official - Suffix:SR
Authorized Official - Credentials:BOCPO CP LPO
Authorized Official - Phone:769-251-0555
Mailing Address - Street 1:445 BROOKWOOD ESTATES DR
Mailing Address - Street 2:
Mailing Address - City:BYRAM
Mailing Address - State:MS
Mailing Address - Zip Code:39272-5661
Mailing Address - Country:US
Mailing Address - Phone:769-251-0555
Mailing Address - Fax:769-251-0366
Practice Address - Street 1:114 BRIDGETON PLZ
Practice Address - Street 2:
Practice Address - City:BYRAM
Practice Address - State:MS
Practice Address - Zip Code:39272-8710
Practice Address - Country:US
Practice Address - Phone:769-251-0555
Practice Address - Fax:769-251-0366
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-31
Last Update Date:2016-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR158078716Medicaid
LA1612553Medicaid
MS03173827Medicaid
AL009940224Medicaid
AR158078716Medicaid
MS5304050001Medicare NSC