Provider Demographics
NPI:1306891247
Name:B.A.KNOTT PROSTHETICS, INC.
Entity type:Organization
Organization Name:B.A.KNOTT PROSTHETICS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICEPRESIDENT/OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:MILLS
Authorized Official - Last Name:KNOTT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:804-355-4773
Mailing Address - Street 1:4912 W MARSHALL ST
Mailing Address - Street 2:SUITE 101
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23230-3127
Mailing Address - Country:US
Mailing Address - Phone:804-355-4773
Mailing Address - Fax:804-359-7268
Practice Address - Street 1:4912 W MARSHALL ST
Practice Address - Street 2:SUITE 101
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23230-3127
Practice Address - Country:US
Practice Address - Phone:804-355-4773
Practice Address - Fax:804-359-7268
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA335E00000X
332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered335E00000XSuppliersProsthetic/Orthotic Supplier
Not Answered332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA91-3376-3Medicaid
VA034118OtherANTHEM PROVIDER #
VA034118OtherANTHEM PROVIDER #