Provider Demographics
NPI:1386082030
Name:BICKERTS ORTHOTICS & PROSTHETICS
Entity type:Organization
Organization Name:BICKERTS ORTHOTICS & PROSTHETICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:PHILIP
Authorized Official - Middle Name:ANTHONY
Authorized Official - Last Name:BICKERT
Authorized Official - Suffix:
Authorized Official - Credentials:CP, LP
Authorized Official - Phone:662-795-4555
Mailing Address - Street 1:PO BOX 2463
Mailing Address - Street 2:
Mailing Address - City:CORINTH
Mailing Address - State:MS
Mailing Address - Zip Code:38835-2463
Mailing Address - Country:US
Mailing Address - Phone:662-795-4555
Mailing Address - Fax:662-643-4131
Practice Address - Street 1:2106 S TATE ST
Practice Address - Street 2:
Practice Address - City:CORINTH
Practice Address - State:MS
Practice Address - Zip Code:38834-7913
Practice Address - Country:US
Practice Address - Phone:662-795-4555
Practice Address - Fax:662-643-4131
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-04
Last Update Date:2015-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS6861320001Medicare NSC