Provider Demographics
NPI:1942849914
Name:AMERICAN BRACE & LIMB ENTERPRISE, LLC
Entity Type:Organization
Organization Name:AMERICAN BRACE & LIMB ENTERPRISE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMEBER
Authorized Official - Prefix:MR
Authorized Official - First Name:JERRY
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:HINTON
Authorized Official - Suffix:
Authorized Official - Credentials:BOCCPO,LPO,LPED
Authorized Official - Phone:423-318-8824
Mailing Address - Street 1:PO BOX 3264
Mailing Address - Street 2:
Mailing Address - City:MORRISTOWN
Mailing Address - State:TN
Mailing Address - Zip Code:37815-3264
Mailing Address - Country:US
Mailing Address - Phone:423-318-8824
Mailing Address - Fax:423-318-2872
Practice Address - Street 1:9333 PARKWEST BLVD.
Practice Address - Street 2:103
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37923
Practice Address - Country:US
Practice Address - Phone:423-318-8824
Practice Address - Fax:423-318-2872
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:AMERICAN BRACE & LIMB ENTERPRISE LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-12-23
Last Update Date:2019-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1454352Medicaid