Provider Demographics
NPI:1124322300
Name:CENTER FOR ORTHOTICS AND PROSTHETICS INC.
Entity type:Organization
Organization Name:CENTER FOR ORTHOTICS AND PROSTHETICS INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JACK
Authorized Official - Middle Name:
Authorized Official - Last Name:STEELE
Authorized Official - Suffix:
Authorized Official - Credentials:CO, LPO
Authorized Official - Phone:901-270-5471
Mailing Address - Street 1:6655 QUINCE RD
Mailing Address - Street 2:SUITE 124
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38119-8031
Mailing Address - Country:US
Mailing Address - Phone:901-757-5461
Mailing Address - Fax:901-757-0909
Practice Address - Street 1:6655 QUINCE RD
Practice Address - Street 2:SUITE 124
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38119-8031
Practice Address - Country:US
Practice Address - Phone:901-757-5461
Practice Address - Fax:901-757-0909
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-03
Last Update Date:2011-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNORT000000015335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN6507760001Medicare NSC