Provider Demographics
NPI:1396556114
Name:865 PROSTHETICS, LLC
Entity type:Organization
Organization Name:865 PROSTHETICS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF CLINICAL OPERATIONS
Authorized Official - Prefix:MR
Authorized Official - First Name:JASON
Authorized Official - Middle Name:L
Authorized Official - Last Name:HAYDEN
Authorized Official - Suffix:
Authorized Official - Credentials:CP
Authorized Official - Phone:865-484-4134
Mailing Address - Street 1:5416 S MIDDLEBROOK PIKE STE A
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37921-5980
Mailing Address - Country:US
Mailing Address - Phone:865-484-4134
Mailing Address - Fax:865-622-5254
Practice Address - Street 1:5416 S MIDDLEBROOK PIKE STE A
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37921-5980
Practice Address - Country:US
Practice Address - Phone:865-484-4134
Practice Address - Fax:865-622-5254
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-01-20
Last Update Date:2025-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetistGroup - Single Specialty