Organization
BRISTOL ORTHOTICS & PROSTHETICS, INC
Active
Parent organization
BRISTOL ORTHOTICS & PROSTHETICS, INC
Organization subpart
Yes
Provider details
NPI number
Legal business name
BRISTOL ORTHOTICS & PROSTHETICS, INC
Authorized official
JOSHUA C GRAYBEAL (CP)
(423) 968-4442
Entity
Organization
Contact information
Practice address
113 SHORT ST, SUITE 5, POUNDING MILL, VA 24637-4278
(276) 963-7786
(276) 963-1187
Mailing address
553 HIGHWAY 126, BRISTOL, TN 37620-1685
(423) 968-4442
(423) 968-4777
Taxonomy
Speciality
Code
Description
License number
State
335E00000X
Prosthetic/Orthotic Supplier
Primary
PRO0000000023
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0009791
BLUR CROSS BLUE SHIELD
TN
05
—
009113827
—
VA
05
—
009190881
—
VA
01
—
1131621
UNITED MINE WORKERS
TN
01
—
141558
ANTHEM
VA
05
—
3539103
—
TN
Enumeration date
05/20/2009
Last updated
04/08/2010
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