Provider Demographics
NPI:1992976013
Name:SPIRIT PROSTHETICS
Entity type:Organization
Organization Name:SPIRIT PROSTHETICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PROSTHETIST
Authorized Official - Prefix:MR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:D
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:CP, LP
Authorized Official - Phone:865-363-3513
Mailing Address - Street 1:4728 TILLERY RD
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37912-5400
Mailing Address - Country:US
Mailing Address - Phone:865-363-3513
Mailing Address - Fax:865-549-4598
Practice Address - Street 1:211 E BLOUNT AVE
Practice Address - Street 2:SUITE 701
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37920-1614
Practice Address - Country:US
Practice Address - Phone:865-549-4599
Practice Address - Fax:865-549-4598
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-17
Last Update Date:2008-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNPRO0000000113261QA0900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0900XAmbulatory Health Care FacilitiesClinic/CenterAmputee