1942849914 NPI number — AMERICAN BRACE & LIMB ENTERPRISE, LLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1942849914 NPI number — AMERICAN BRACE & LIMB ENTERPRISE, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
AMERICAN BRACE & LIMB ENTERPRISE, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1942849914
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/23/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 3264
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MORRISTOWN
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37815-3264
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
423-318-8824
Provider Business Mailing Address Fax Number:
423-318-2872

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9333 PARKWEST BLVD.
Provider Second Line Business Practice Location Address:
103
Provider Business Practice Location Address City Name:
KNOXVILLE
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37923
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
423-318-8824
Provider Business Practice Location Address Fax Number:
423-318-2872
Provider Enumeration Date:
12/23/2019

Additional Information

Authorized Official

Authorized Official Last Name:
HINTON
Authorized Official First Name:
JERRY
Authorized Official Middle Name:
DAVID
Authorized Official Title or Position:
MEMEBER
Authorized Official Telephone Number:
423-318-8824

Provider Taxonomy Codes

  • Taxonomy code: 335E00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1454352 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".




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