Provider Demographics
NPI:1215932801
Name:CLARKSVILLE LIMB & BRACE & REHAB., INC.
Entity type:Organization
Organization Name:CLARKSVILLE LIMB & BRACE & REHAB., INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:JUDY
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:FARRIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:931-648-2155
Mailing Address - Street 1:980 PROFESSIONAL PARK DR STE B
Mailing Address - Street 2:
Mailing Address - City:CLARKSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37040-5251
Mailing Address - Country:US
Mailing Address - Phone:931-648-2155
Mailing Address - Fax:931-647-4952
Practice Address - Street 1:230 S FRANKLIN ST
Practice Address - Street 2:
Practice Address - City:RUSSELLVILLE
Practice Address - State:KY
Practice Address - Zip Code:42276-1937
Practice Address - Country:US
Practice Address - Phone:270-726-1200
Practice Address - Fax:270-726-8644
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-20
Last Update Date:2021-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1744P3200XOther Service ProvidersSpecialistProsthetics Case ManagementGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000070507OtherANTHEM
KY90262569Medicaid
KY0127980003Medicare NSC