1114278900 NPI number — BULOW BIOTECH PROSTHETICS, LLC

Table of content: RIA MARCELINA GUZMAN D.D.S. (NPI 1871507384)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1114278900 NPI number — BULOW BIOTECH PROSTHETICS, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BULOW BIOTECH PROSTHETICS, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1114278900
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/09/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
102 WOODMONT BLVD
Provider Second Line Business Mailing Address:
SUITE120
Provider Business Mailing Address City Name:
NASHVILLE
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37205-2287
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
615-864-8788
Provider Business Mailing Address Fax Number:
615-454-5352

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1601 E 19TH AVE
Provider Second Line Business Practice Location Address:
5200
Provider Business Practice Location Address City Name:
DENVER
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80218-1216
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
303-831-5997
Provider Business Practice Location Address Fax Number:
303-831-6295
Provider Enumeration Date:
09/20/2012

Additional Information

Authorized Official

Authorized Official Last Name:
GARDNER
Authorized Official First Name:
BRADFORD
Authorized Official Middle Name:
NEIL
Authorized Official Title or Position:
COO
Authorized Official Telephone Number:
615-864-8783

Provider Taxonomy Codes

  • Taxonomy code: 335E00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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