Organization
NEW LIFE PROSTHETICS CORPORATION
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. ROGER TERRY COOK CP (CERTIFIED PROSTHETIST/OWNER)
(423) 949-8620
Entity
Organization
Contact information
Practice address
87 NELMS RD, GRAYSVILLE, TN 37338-4632
(423) 949-8620
(423) 949-9217
Mailing address
87 NELMS RD, GRAYSVILLE, TN 37338-4632
(423) 949-8620
Taxonomy
Speciality
Code
Description
License number
State
335E00000X
Prosthetic/Orthotic Supplier
Primary
PRO0000000083
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1454290
—
TN
05
—
198356168A
—
GA
01
—
4067689
BLUE CROSS BLUE SHIELD TN
TN
01
—
TN0100
AMERICHOICE/TENNCARE
TN
Enumeration date
12/11/2007
Last updated
08/25/2008
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