Organization
MOBILE PROSTHETICS OF KENTUCKY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TONY GARRETT COOK LCP (PRESIDENT)
(270) 465-8522
Entity
Organization
Contact information
Practice address
610 W MAIN ST, STE E, CAMPBELLSVILLE, KY 42718-2501
(270) 465-8522
(270) 465-8523
Mailing address
610 W MAIN ST, STE E, CAMPBELLSVILLE, KY 42718-2501
(270) 465-8522
(270) 465-8523
Taxonomy
Speciality
Code
Description
License number
State
335E00000X
Prosthetic/Orthotic Supplier
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000788517
ATHEM BLUE CROSS AND BLUE SHIELD
KY
05
—
7100209830
—
KY
Enumeration date
11/22/2011
Last updated
12/03/2012
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