1427239748 NPI number — ODOMS PROSTHETICS INC

Table of content: (NPI 1427239748)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1427239748 NPI number — ODOMS PROSTHETICS INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ODOMS 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:
1427239748
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/23/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
745 TROY TRL
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LEXINGTON
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
40517-1958
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
859-273-3928
Provider Business Mailing Address Fax Number:
859-273-0038

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2785 N MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HAZARD
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
41701-5910
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
859-273-3928
Provider Business Practice Location Address Fax Number:
859-273-0038
Provider Enumeration Date:
11/15/2007

Additional Information

Authorized Official

Authorized Official Last Name:
ODOM
Authorized Official First Name:
RON
Authorized Official Middle Name:
J
Authorized Official Title or Position:
PROSTHETIST/ OWNER
Authorized Official Telephone Number:
859-273-3928

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: 90090572 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com