Provider Demographics
NPI:1932742079
Name:RYAN FANN PROSTHETICS, LLC
Entity Type:Organization
Organization Name:RYAN FANN PROSTHETICS, LLC
Other - Org Name:REFORM PROSTHETICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGING OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOSHUA
Authorized Official - Middle Name:RYAN
Authorized Official - Last Name:FANN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-579-8407
Mailing Address - Street 1:1609 E 50TH ST
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31404-4211
Mailing Address - Country:US
Mailing Address - Phone:615-579-8407
Mailing Address - Fax:
Practice Address - Street 1:918 E 72ND ST
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31405-4917
Practice Address - Country:US
Practice Address - Phone:912-344-9599
Practice Address - Fax:912-335-3435
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-22
Last Update Date:2023-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes335E00000XSuppliersProsthetic/Orthotic SupplierGroup - Single Specialty
No224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetistGroup - Single Specialty