Provider Demographics
NPI:1982988390
Name:BULOW BIOTECH PROSTHETICS, LLC
Entity type:Organization
Organization Name:BULOW BIOTECH PROSTHETICS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:BRAD
Authorized Official - Middle Name:
Authorized Official - Last Name:GARDNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-864-8783
Mailing Address - Street 1:102 WOODMONT BLVD
Mailing Address - Street 2:SUITE 120
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37205-2287
Mailing Address - Country:US
Mailing Address - Phone:615-864-8788
Mailing Address - Fax:
Practice Address - Street 1:10114 HUEBNER RD
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78240-1319
Practice Address - Country:US
Practice Address - Phone:210-614-4077
Practice Address - Fax:210-614-4075
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-04
Last Update Date:2017-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier