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Organization

AKBK

Active
Other names
Crockett Prosthetics & Orthotics
Organization subpart
No

Provider details

NPI number
Authorized official
MR. PETER PAUL KOSLOSKI CPO, FAAOP (OWNER/PRESIDENT)
(865) 688-2626
Entity
Organization

Contact information

Practice address
4503 WALKER BLVD, KNOXVILLE, TN 37917-1526
(865) 688-2626
(865) 688-3647
Mailing address
4503 WALKER BLVD, KNOXVILLE, TN 37917-1526
(865) 688-2626
(865) 688-3647

Taxonomy

Speciality
Code
Description
License number
State
335E00000X
Prosthetic/Orthotic Supplier
Primary

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
0086519
BLUE CROOS BLUE SHEILD
TN
05
3555750
TN
Enumeration date
08/17/2006
Last updated
03/20/2012
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