1306891247 NPI number — B.A.KNOTT PROSTHETICS, INC.

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 1306891247 NPI number — B.A.KNOTT PROSTHETICS, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
B.A.KNOTT PROSTHETICS, 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:
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:
1306891247
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:
4912 W MARSHALL ST
Provider Second Line Business Mailing Address:
SUITE 101
Provider Business Mailing Address City Name:
RICHMOND
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
23230-3127
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
804-355-4773
Provider Business Mailing Address Fax Number:
804-359-7268

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4912 W MARSHALL ST
Provider Second Line Business Practice Location Address:
SUITE 101
Provider Business Practice Location Address City Name:
RICHMOND
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
23230-3127
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
804-355-4773
Provider Business Practice Location Address Fax Number:
804-359-7268
Provider Enumeration Date:
05/22/2006

Additional Information

Authorized Official

Authorized Official Last Name:
KNOTT
Authorized Official First Name:
LINDA
Authorized Official Middle Name:
MILLS
Authorized Official Title or Position:
VICEPRESIDENT/OWNER
Authorized Official Telephone Number:
804-355-4773

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 335E00000X , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .

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

  • Identifier: 91-3376-3 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 034118 . This is a "ANTHEM PROVIDER #" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".




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