Provider Demographics
NPI:1871765883
Name:ANDERSON BRACE & LIMB PLLC
Entity type:Organization
Organization Name:ANDERSON BRACE & LIMB PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CERTIFIED PROSTHETIST ORTHOTI
Authorized Official - Prefix:MR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:WESLEY
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:CPO
Authorized Official - Phone:731-286-6006
Mailing Address - Street 1:300 E PARKVIEW ST
Mailing Address - Street 2:
Mailing Address - City:DYERSBURG
Mailing Address - State:TN
Mailing Address - Zip Code:38024-3110
Mailing Address - Country:US
Mailing Address - Phone:731-286-6006
Mailing Address - Fax:731-286-5570
Practice Address - Street 1:300 E PARKVIEW ST
Practice Address - Street 2:
Practice Address - City:DYERSBURG
Practice Address - State:TN
Practice Address - Zip Code:38024-3110
Practice Address - Country:US
Practice Address - Phone:731-286-6006
Practice Address - Fax:731-286-5570
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-31
Last Update Date:2017-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNPRO0000000087335E00000X
TNORT0000000109335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
4804280001Medicare NSC