Provider Demographics
NPI:1427239748
Name:ODOMS PROSTHETICS INC
Entity type:Organization
Organization Name:ODOMS PROSTHETICS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROSTHETIST/ OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RON
Authorized Official - Middle Name:J
Authorized Official - Last Name:ODOM
Authorized Official - Suffix:
Authorized Official - Credentials:CP
Authorized Official - Phone:859-273-3928
Mailing Address - Street 1:745 TROY TRL
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40517-1958
Mailing Address - Country:US
Mailing Address - Phone:859-273-3928
Mailing Address - Fax:859-273-0038
Practice Address - Street 1:2785 N MAIN ST
Practice Address - Street 2:
Practice Address - City:HAZARD
Practice Address - State:KY
Practice Address - Zip Code:41701-5910
Practice Address - Country:US
Practice Address - Phone:859-273-3928
Practice Address - Fax:859-273-0038
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-15
Last Update Date:2009-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY90090572Medicaid
KY1230670001Medicare NSC