Provider Demographics
NPI:1942477344
Name:BULOW BIOTECH PROSTHETICS, LLC
Entity Type:Organization
Organization Name:BULOW BIOTECH PROSTHETICS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:BRADFORD
Authorized Official - Middle Name:NEIL
Authorized Official - Last Name:GARDNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-864-8783
Mailing Address - Street 1:102 WOODMONT BLVD
Mailing Address - Street 2:SUITE 120
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37205-2287
Mailing Address - Country:US
Mailing Address - Phone:615-864-8788
Mailing Address - Fax:615-454-5352
Practice Address - Street 1:6736 CHARLOTTE PIKE STE 101
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37209-4290
Practice Address - Country:US
Practice Address - Phone:615-712-7261
Practice Address - Fax:615-712-7264
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-14
Last Update Date:2018-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1511922Medicaid
TN5748770003Medicare NSC