Organization
BREAST PROSTHESES & ORTHOTICS INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JANICE MCCRACKEN (OWNER)
(423) 573-8500
Entity
Organization
Contact information
Practice address
1850 EDGEMONT AVE, BRISTOL, TN 37620-4309
(423) 573-8500
(423) 573-8501
Mailing address
1850 EDGEMONT AVE, BRISTOL, TN 37620-4309
(423) 573-8500
(423) 573-8501
Taxonomy
Speciality
Code
Description
License number
State
225000000X
Orthotic Fitter
Primary
—
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
337633
BC
VA
05
—
9190350
—
VA
Enumeration date
07/07/2006
Last updated
07/21/2022
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