Provider Demographics
NPI:1063179497
Name:XTREME PROSTHETICS, LLC.
Entity type:Organization
Organization Name:XTREME PROSTHETICS, LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP OF FINANCE, CONTROLLER
Authorized Official - Prefix:
Authorized Official - First Name:AARON
Authorized Official - Middle Name:
Authorized Official - Last Name:KRATOHVIL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-550-8760
Mailing Address - Street 1:102 WOODMONT BLVD STE 120
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37205-5249
Mailing Address - Country:US
Mailing Address - Phone:161-586-4879
Mailing Address - Fax:
Practice Address - Street 1:4122 SHELBYVILLE RD STE 108
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40207-3206
Practice Address - Country:US
Practice Address - Phone:503-308-4144
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-19
Last Update Date:2021-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier