1972229797 NPI number — BTB ORTHOTIC AND PROSTHETIC SOLUTIONS LLC

Table of content: (NPI 1972229797)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1972229797 NPI number — BTB ORTHOTIC AND PROSTHETIC SOLUTIONS LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BTB ORTHOTIC AND PROSTHETIC SOLUTIONS 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:
6
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:
1972229797
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/06/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
121 AUTUMN HLS
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TUPELO
Provider Business Mailing Address State Name:
MS
Provider Business Mailing Address Postal Code:
38801-8027
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
662-213-3617
Provider Business Mailing Address Fax Number:
662-798-0481

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
425 HOSPITAL DR STE 3
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
COLUMBUS
Provider Business Practice Location Address State Name:
MS
Provider Business Practice Location Address Postal Code:
39705-1938
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
662-213-3017
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/13/2022

Additional Information

Authorized Official

Authorized Official Last Name:
BURKS
Authorized Official First Name:
TAYLOR
Authorized Official Middle Name:
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
662-213-3617

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 335E00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2025 www.npivalidator.com