Organization
ROCKY MOUNTAIN ARTIFICIAL LIMB & BRACE, INC
Active
Parent organization
BULOW HOLDINGS, LLC
Organization subpart
Yes
Provider details
NPI number
Legal business name
BULOW HOLDINGS, LLC
Authorized official
BRADFORD GARDNER (VP, COO)
(615) 550-8760
Entity
Organization
Contact information
Practice address
2350 VIA CAPORATTI DR STE B, POCATELLO, ID 83201-5095
(208) 232-6611
(208) 232-6612
Mailing address
102 WOODMONT BLVD, SUITE 120, NASHVILLE, TN 37205
(615) 550-8774
(615) 454-5352
Taxonomy
Speciality
Code
Description
License number
State
335E00000X
Prosthetic/Orthotic Supplier
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
89730
BLUE CROSS OF IDAHO
ID
Enumeration date
11/28/2006
Last updated
09/26/2024
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