Organization
MEMPHIS ORTHOPAEDIC MEDICAL SUPPLIES,LLC.
Active
Other names
Metro Orthotics
Organization subpart
No
Provider details
NPI number
Authorized official
MR. GUY FRED WALLACE CO (PRESIDENT)
(901) 755-4344
Entity
Organization
Contact information
Practice address
2809 KIRBY PARKWAY, SUITE 105, MEMPHIS, TN 38119-8241
(901) 755-4344
(901) 755-4099
Mailing address
2809 KIRBY PARKWAY, SUITE 105, MEMPHIS, TN 38119-8241
(901) 755-4344
(901) 755-4099
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
TN
335E00000X
Prosthetic/Orthotic Supplier
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1452529
—
TN
01
—
3160043
BLUECROSS BLUESHIELD
TN
Enumeration date
07/13/2005
Last updated
09/11/2025
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