Provider Demographics
NPI:1194849836
Name:SCOTT COUNTY LIMB & BRACE
Entity type:Organization
Organization Name:SCOTT COUNTY LIMB & BRACE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:P
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:CPBOCP
Authorized Official - Phone:812-752-1014
Mailing Address - Street 1:1366 N GARDNER ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:SCOTTSBURG
Mailing Address - State:IN
Mailing Address - Zip Code:47170-7793
Mailing Address - Country:US
Mailing Address - Phone:812-752-1014
Mailing Address - Fax:
Practice Address - Street 1:1366 N GARDNER ST
Practice Address - Street 2:SUITE 100
Practice Address - City:SCOTTSBURG
Practice Address - State:IN
Practice Address - Zip Code:47170-7793
Practice Address - Country:US
Practice Address - Phone:812-752-1014
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN5734680001Medicare ID - Type Unspecified