Provider Demographics
NPI:1740451178
Name:MORRISTOWN ORTHOTICS & PROSTHETICS LLC
Entity type:Organization
Organization Name:MORRISTOWN ORTHOTICS & PROSTHETICS LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:TERRY
Authorized Official - Middle Name:M
Authorized Official - Last Name:PARSONS
Authorized Official - Suffix:
Authorized Official - Credentials:COF
Authorized Official - Phone:423-586-4455
Mailing Address - Street 1:1457 W MORRIS BLVD
Mailing Address - Street 2:
Mailing Address - City:MORRISTOWN
Mailing Address - State:TN
Mailing Address - Zip Code:37813-2828
Mailing Address - Country:US
Mailing Address - Phone:423-586-4455
Mailing Address - Fax:423-586-8181
Practice Address - Street 1:1457 W MORRIS BLVD
Practice Address - Street 2:
Practice Address - City:MORRISTOWN
Practice Address - State:TN
Practice Address - Zip Code:37813-2828
Practice Address - Country:US
Practice Address - Phone:423-586-4455
Practice Address - Fax:423-586-8181
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-13
Last Update Date:2008-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNCP 2127 CO 1603261QM1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1452176Medicaid
173406OtherBLUE CARE
TN173406OtherBLUE CROSS BLUE SHIELD
TN173406OtherTENN CARE SELECT
TN=========OtherAMERICHOICE
TN173406OtherTENN CARE SELECT