Provider Demographics
NPI:1972229797
Name:BTB ORTHOTIC AND PROSTHETIC SOLUTIONS LLC
Entity type:Organization
Organization Name:BTB ORTHOTIC AND PROSTHETIC SOLUTIONS LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:TAYLOR
Authorized Official - Middle Name:
Authorized Official - Last Name:BURKS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:662-213-3617
Mailing Address - Street 1:121 AUTUMN HLS
Mailing Address - Street 2:
Mailing Address - City:TUPELO
Mailing Address - State:MS
Mailing Address - Zip Code:38801-8027
Mailing Address - Country:US
Mailing Address - Phone:662-213-3617
Mailing Address - Fax:662-798-0481
Practice Address - Street 1:425 HOSPITAL DR STE 3
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:MS
Practice Address - Zip Code:39705-1938
Practice Address - Country:US
Practice Address - Phone:662-213-3017
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-10-13
Last Update Date:2024-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes335E00000XSuppliersProsthetic/Orthotic SupplierGroup - Multi-Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Multi-Specialty