Provider Demographics
NPI:1902434699
Name:FLEMONS PROSTHETICS
Entity Type:Organization
Organization Name:FLEMONS PROSTHETICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:COURTNEY
Authorized Official - Middle Name:
Authorized Official - Last Name:FLEMONS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:901-942-8258
Mailing Address - Street 1:9305 STATELINE RD APT 33B
Mailing Address - Street 2:
Mailing Address - City:OLIVE BRANCH
Mailing Address - State:MS
Mailing Address - Zip Code:38654-3772
Mailing Address - Country:US
Mailing Address - Phone:901-942-8258
Mailing Address - Fax:
Practice Address - Street 1:9305 STATELINE RD APT 33B
Practice Address - Street 2:
Practice Address - City:OLIVE BRANCH
Practice Address - State:MS
Practice Address - Zip Code:38654-3772
Practice Address - Country:US
Practice Address - Phone:901-942-8258
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-03-30
Last Update Date:2020-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier