Provider Demographics
NPI:1831193283
Name:SPEARS, MICAH BRITT (CPO)
Entity type:Individual
Prefix:MR
First Name:MICAH
Middle Name:BRITT
Last Name:SPEARS
Suffix:
Gender:M
Credentials:CPO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5402 BRANTFORD AVE.
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38120-2440
Mailing Address - Country:US
Mailing Address - Phone:901-767-3665
Mailing Address - Fax:501-206-3505
Practice Address - Street 1:2000 HWY 25B. N.
Practice Address - Street 2:SUITE C-1
Practice Address - City:HEBER SPRINGS
Practice Address - State:AR
Practice Address - Zip Code:72543
Practice Address - Country:US
Practice Address - Phone:501-206-3500
Practice Address - Fax:501-206-3505
Is Sole Proprietor?:No
Enumeration Date:2005-06-13
Last Update Date:2008-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetist
No222Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR49849OtherBLUE CROSS BLUE SHIELD
AR49849OtherBLUE CROSS BLUE SHIELD