Provider Demographics
NPI:1184451973
Name:RX ORTHOPEDICS CARE LLC
Entity type:Organization
Organization Name:RX ORTHOPEDICS CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SAMUEL
Authorized Official - Middle Name:T
Authorized Official - Last Name:WILLIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:470-850-1639
Mailing Address - Street 1:705 WINDCHASE LN
Mailing Address - Street 2:
Mailing Address - City:STONE MOUNTAIN
Mailing Address - State:GA
Mailing Address - Zip Code:30083-6327
Mailing Address - Country:US
Mailing Address - Phone:470-850-1639
Mailing Address - Fax:
Practice Address - Street 1:1835 E PARK PLACE BLVD STE 115
Practice Address - Street 2:
Practice Address - City:STONE MTN
Practice Address - State:GA
Practice Address - Zip Code:30087-3457
Practice Address - Country:US
Practice Address - Phone:470-850-1639
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-09-17
Last Update Date:2024-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies