Provider Demographics
NPI:1356150973
Name:SV ORTHOTIC & PROSTETIC COMPANY
Entity type:Organization
Organization Name:SV ORTHOTIC & PROSTETIC COMPANY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:GIRI
Authorized Official - Middle Name:
Authorized Official - Last Name:TALLURI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:608-772-9021
Mailing Address - Street 1:5735 BEAVER RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:CUMMING
Mailing Address - State:GA
Mailing Address - Zip Code:30040-0206
Mailing Address - Country:US
Mailing Address - Phone:608-772-9021
Mailing Address - Fax:
Practice Address - Street 1:1100 JOHNSON FERRY RD STE BUILDING II, SUITE LL80
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30342-1709
Practice Address - Country:US
Practice Address - Phone:608-772-9021
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-01-07
Last Update Date:2025-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No335E00000XSuppliersProsthetic/Orthotic Supplier