Organization
WILSON BRACE AND LIMB COMPANY INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JIMMY WILSON CPO (PRESIDENT)
(601) 982-9060
Entity
Organization
Contact information
Practice address
500J E WOODROW WILSON AVE, JACKSON, MS 39216-4538
(601) 982-9060
(601) 362-9911
Mailing address
500J E WOODROW WILSON AVE, JACKSON, MS 39216-4538
(601) 982-9060
(601) 362-9911
Taxonomy
Speciality
Code
Description
License number
State
335E00000X
Prosthetic/Orthotic Supplier
Primary
CPO02517
DE
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00040660
—
MS
Enumeration date
07/01/2006
Last updated
10/03/2007
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