Provider Demographics
NPI:1205908506
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:CO-OWNER
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:BOCPO, CO, 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 1:1044 S CUMBERLAND ST
Practice Address - Street 2:
Practice Address - City:MORRISTOWN
Practice Address - State:TN
Practice Address - Zip Code:37813-5235
Practice Address - Country:US
Practice Address - Phone:423-318-8824
Practice Address - Fax:423-318-2872
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-14
Last Update Date:2019-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNORT0000000108335E00000X
TNPED0000000060335E00000X
TNPRO0000000072335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1454352Medicaid
TN4455470001Medicare NSC