Organization
AKBK
Active
Other names
CROCKETT PROSTHETICS & ORTHOTICS
Organization subpart
No
Provider details
NPI number
Authorized official
MR. PETER PAUL KOSLOSKI CPO,FAAOP (OWNER/PRESIDENT)
(865) 688-2626
Entity
Organization
Contact information
Practice address
10932 MURDOCK DR, SUITE 105A, KNOXVILLE, TN 37932-3239
(865) 675-2873
(865) 675-2879
Mailing address
4503 WALKER BLVD, KNOXVILLE, TN 37917-1526
(865) 688-2626
(865) 688-3647
Taxonomy
Speciality
Code
Description
License number
State
335E00000X
Prosthetic/Orthotic Supplier
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3555750
—
TN
01
—
86519
BLUE CROSS BLUE SHIELD
TN
Enumeration date
10/09/2006
Last updated
03/20/2012
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