Provider Demographics
NPI:1316093388
Name:SPEARS PROSTHETICS AND ORTHOTICS LLC
Entity type:Organization
Organization Name:SPEARS PROSTHETICS AND ORTHOTICS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MICAH
Authorized Official - Middle Name:B
Authorized Official - Last Name:SPEARS
Authorized Official - Suffix:
Authorized Official - Credentials:CPO
Authorized Official - Phone:901-763-6999
Mailing Address - Street 1:722 N WHITE STATION RD
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38122-4422
Mailing Address - Country:US
Mailing Address - Phone:901-763-6999
Mailing Address - Fax:901-682-9062
Practice Address - Street 1:722 N WHITE STATION RD
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38122-4422
Practice Address - Country:US
Practice Address - Phone:901-763-6999
Practice Address - Fax:901-682-9062
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-25
Last Update Date:2013-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1455102Medicaid
TN4814620002OtherPTAN