Provider Demographics
NPI:1669718359
Name:BLUFF PROSTHETICS & ORTHOTICS, LLC D/B/A SEMO PROSTHETICS & ORTHOTICS
Entity type:Organization
Organization Name:BLUFF PROSTHETICS & ORTHOTICS, LLC D/B/A SEMO PROSTHETICS & ORTHOTICS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CP
Authorized Official - Prefix:MR
Authorized Official - First Name:HORACE
Authorized Official - Middle Name:
Authorized Official - Last Name:HODGES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:573-778-3700
Mailing Address - Street 1:2534 WILLIAM ST
Mailing Address - Street 2:
Mailing Address - City:CAPE GIRARDEAU
Mailing Address - State:MO
Mailing Address - Zip Code:63703-5763
Mailing Address - Country:US
Mailing Address - Phone:573-332-1015
Mailing Address - Fax:573-332-1030
Practice Address - Street 1:2534 WILLIAM ST
Practice Address - Street 2:
Practice Address - City:CAPE GIRARDEAU
Practice Address - State:MO
Practice Address - Zip Code:63703-5763
Practice Address - Country:US
Practice Address - Phone:573-332-1015
Practice Address - Fax:573-332-1030
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BLUFF PROSTHETICS & ORTHOTICS, LLC D/B/A SEMO PROSTHETICS & ORTHOTICS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-12-27
Last Update Date:2021-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier