1124039151 NPI number — HOME CARE ORTHOTICS INC

Table of content: (NPI 1124039151)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1124039151 NPI number — HOME CARE ORTHOTICS INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HOME CARE ORTHOTICS INC
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:
HC ORTHOTICS & PROSTHETICS
Provider Other Organization Name Type Code:
3
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:
1124039151
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
917 DOLLY PARTON PARKWAY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SEVIERVILLE
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37862
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
865-774-9959
Provider Business Mailing Address Fax Number:
865-774-9953

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
917 DOLLY PARTON PARKWAY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SEVIERVILLE
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37862
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
865-774-9959
Provider Business Practice Location Address Fax Number:
865-774-9953
Provider Enumeration Date:
08/11/2006

Additional Information

Authorized Official

Authorized Official Last Name:
BRACKINS
Authorized Official First Name:
MISTY
Authorized Official Middle Name:
DAWN
Authorized Official Title or Position:
VICE PRESIDENT OFFICE MANAGER
Authorized Official Telephone Number:
865-774-9959

Provider Taxonomy Codes

  • Taxonomy code: 335E00000X , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 335E00000X , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .

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

  • Identifier: 1452154 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 3042541 . This is a "BCBS OF TN" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".




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