Provider Demographics
NPI:1245534585
Name:XTREME PROSTHETICS, LLC.
Entity type:Organization
Organization Name:XTREME PROSTHETICS, LLC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:VP OF FINANCE, CONTROLLER
Authorized Official - Prefix:MR
Authorized Official - First Name:AARON
Authorized Official - Middle Name:E
Authorized Official - Last Name:KRATOHVIL
Authorized Official - Suffix:JR
Authorized Official - Credentials:CPO
Authorized Official - Phone:615-550-8760
Mailing Address - Street 1:1005 WEST COLUMBIA ST.
Mailing Address - Street 2:SUITE B
Mailing Address - City:SOMERSET
Mailing Address - State:KY
Mailing Address - Zip Code:42503
Mailing Address - Country:US
Mailing Address - Phone:606-451-0668
Mailing Address - Fax:606-451-0078
Practice Address - Street 1:1005 WEST COLUMBIA ST
Practice Address - Street 2:SUITE B
Practice Address - City:SOMERSET
Practice Address - State:KY
Practice Address - Zip Code:42503
Practice Address - Country:US
Practice Address - Phone:606-451-0668
Practice Address - Fax:606-451-0078
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-30
Last Update Date:2021-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY6469320001OtherPTAN
KY1245534585OtherNPI