Provider Demographics
NPI:1548697154
Name:BULOW PROVIDER NETWORK, LLC
Entity type:Organization
Organization Name:BULOW PROVIDER NETWORK, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:VP OF CLINIC OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:
Authorized Official - Last Name:BYRD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-864-8788
Mailing Address - Street 1:102 WOODMONT AVE.
Mailing Address - Street 2:SUITE 120
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37205-2287
Mailing Address - Country:US
Mailing Address - Phone:615-864-8788
Mailing Address - Fax:615-454-5352
Practice Address - Street 1:499 E HAMPDEN AVE
Practice Address - Street 2:SUITE 140
Practice Address - City:ENGLEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80113-2780
Practice Address - Country:US
Practice Address - Phone:303-831-6162
Practice Address - Fax:303-831-6295
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BULOW BIOTECH PROSTHETICS, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-09-27
Last Update Date:2013-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty