Organization
JACKSON BRACE AND LIMB COMPANY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MICKI CORLEY (OFFICE MANAGER)
(601) 353-2477
Entity
Organization
Contact information
Practice address
1320 N STATE ST, JACKSON, MS 39202-2003
(601) 353-2477
(601) 355-4100
Mailing address
1320 N STATE ST, JACKSON, MS 39202-2096
(601) 353-2477
(601) 355-4100
Taxonomy
Speciality
Code
Description
License number
State
335E00000X
Prosthetic/Orthotic Supplier
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000012226
BLUE CROSS BLUE SHIELD
MS
05
—
00040095
—
MS
Enumeration date
11/22/2006
Last updated
11/07/2025
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