Provider Demographics
NPI:1801077367
Name:ALEXANDER PROSTHETICS & ORTHOTICS, INC
Entity type:Organization
Organization Name:ALEXANDER PROSTHETICS & ORTHOTICS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARY/TREASURER
Authorized Official - Prefix:
Authorized Official - First Name:SHARON
Authorized Official - Middle Name:E
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:CO, BOCO, CPED
Authorized Official - Phone:423-288-8599
Mailing Address - Street 1:716 SPRING AVE NE
Mailing Address - Street 2:P. O. BOX 3425
Mailing Address - City:WISE
Mailing Address - State:VA
Mailing Address - Zip Code:24293-5702
Mailing Address - Country:US
Mailing Address - Phone:276-328-6200
Mailing Address - Fax:423-343-5654
Practice Address - Street 1:716 SPRING AVE NE
Practice Address - Street 2:
Practice Address - City:WISE
Practice Address - State:VA
Practice Address - Zip Code:24293-5702
Practice Address - Country:US
Practice Address - Phone:276-328-6200
Practice Address - Fax:423-343-5654
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ALEXANDER PROSTHETICS & ORTHOTICS, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-11-26
Last Update Date:2007-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
VATN0102OtherUNITED HEALTH CARE
KY90122664Medicaid
VA702010907OtherCARITEN HEALTH CARE
VA9190333Medicaid
VA095660OtherANTHEM BCBS
KY90122664Medicaid