Provider Demographics
NPI:1982670964
Name:APPALACHIAN PROSTHETIC & ORTHOTIC SERVICES, INC
Entity Type:Organization
Organization Name:APPALACHIAN PROSTHETIC & ORTHOTIC SERVICES, INC
Other - Org Name:ALEXANDER PROSTHETICS & ORTHOTICS, INC.
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:SECRETARY TREASURER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHARON
Authorized Official - Middle Name:E
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:CO BOCO CPED
Authorized Official - Phone:423-288-8599
Mailing Address - Street 1:3551 E STONE DR
Mailing Address - Street 2:
Mailing Address - City:KINGSPORT
Mailing Address - State:TN
Mailing Address - Zip Code:37660-7115
Mailing Address - Country:US
Mailing Address - Phone:423-288-8599
Mailing Address - Fax:423-288-5227
Practice Address - Street 1:3551 E STONE DR
Practice Address - Street 2:
Practice Address - City:KINGSPORT
Practice Address - State:TN
Practice Address - Zip Code:37660-7115
Practice Address - Country:US
Practice Address - Phone:423-288-8599
Practice Address - Fax:423-288-5227
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-28
Last Update Date:2015-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1452100Medicaid
TN702010907OtherCARITEN HEALTH CARE
KY90122664Medicaid
VA9190821Medicaid
TN3015258OtherBCBS
TNTN0101OtherUNITED HEALTH CARE
TNTN0101OtherUNITED HEALTH CARE