Provider Demographics
NPI:1376371948
Name:CROSSROADS PROSTHETICS AND ORTHOTICS
Entity type:Organization
Organization Name:CROSSROADS PROSTHETICS AND ORTHOTICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:423-656-3987
Mailing Address - Street 1:3900 BRISTOL HWY STE 8
Mailing Address - Street 2:
Mailing Address - City:JOHNSON CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37601-1391
Mailing Address - Country:US
Mailing Address - Phone:423-656-3987
Mailing Address - Fax:
Practice Address - Street 1:3900 BRISTOL HWY STE 8
Practice Address - Street 2:
Practice Address - City:JOHNSON CITY
Practice Address - State:TN
Practice Address - Zip Code:37601-1391
Practice Address - Country:US
Practice Address - Phone:423-900-2425
Practice Address - Fax:423-900-2426
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-24
Last Update Date:2024-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier