Organization
CLARKSVILLE LIMB & BRACE & REHAB., INC.
Active
Other names
Russellville Orthotics & Prosthetics
Organization subpart
No
Provider details
NPI number
Authorized official
MS. JUDY LYNN FARRIS (OFFICE MANAGER)
(931) 648-2155
Entity
Organization
Contact information
Practice address
230 S FRANKLIN ST, RUSSELLVILLE, KY 42276-1937
(270) 726-1200
(270) 726-8644
Mailing address
980 PROFESSIONAL PARK DR STE B, CLARKSVILLE, TN 37040-5251
(931) 648-2155
(931) 647-4952
Taxonomy
Speciality
Code
Description
License number
State
1744P3200X
Prosthetics Case Management
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000070507
ANTHEM
KY
05
—
90262569
—
KY
Enumeration date
06/20/2005
Last updated
07/07/2021
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