1245534585 NPI number — XTREME PROSTHETICS, LLC.

Table of content: (NPI 1245534585)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1245534585 NPI number — XTREME PROSTHETICS, LLC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
XTREME PROSTHETICS, 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:
XTREME PROSTHETICS & ORTHOTICS, LLC
Provider Other Organization Name Type Code:
4
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:
1245534585
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/14/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1005 WEST COLUMBIA ST.
Provider Second Line Business Mailing Address:
SUITE B
Provider Business Mailing Address City Name:
SOMERSET
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
42503
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
606-451-0668
Provider Business Mailing Address Fax Number:
606-451-0078

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1005 WEST COLUMBIA ST
Provider Second Line Business Practice Location Address:
SUITE B
Provider Business Practice Location Address City Name:
SOMERSET
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
42503
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-451-0668
Provider Business Practice Location Address Fax Number:
606-451-0078
Provider Enumeration Date:
12/30/2010

Additional Information

Authorized Official

Authorized Official Last Name:
KRATOHVIL
Authorized Official First Name:
AARON
Authorized Official Middle Name:
E
Authorized Official Title or Position:
VP OF FINANCE, CONTROLLER
Authorized Official Telephone Number:
615-550-8760

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: 6469320001 . This is a "PTAN" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 1245534585 . This is a "NPI" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".




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