NPIMap

Organization Active NPI

Fourroux Prosthetics, Inc

  • Prosthetic/Orthotic Supplier
  • Memphis, TN
National Provider Identifier
1386788636
Registry record updated Jun 12, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Prosthetic/Orthotic SupplierTaxonomy code 335E00000X
Legal business name
FOURROUX PROSTHETICS, INC
Practice address
6740 Reese Road
Memphis, TN 38133-4978
Phone
(901) 383-1837
Fax
(800) 963-5010
NPI assigned
Feb 19, 2007
Last updated
Jun 12, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 12, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mr. W Keith Watson, CPO
Title
Owner/President
Phone
(256) 534-8672

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Prosthetic/Orthotic Supplier 335E00000X TN Primary

Addresses

Primary practice location

6740 Reese Road
Memphis, TN 38133-4978

Mailing address

2743 Bob Wallace Ave SW
Huntsville, AL 35805
Phone (256) 534-8672

Other identifiers 2

IdentifierTypeStateIssuer
1530932MedicaidTN
4336479OtherTNBCBS OF TENNESSEE

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TN

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20120918000684 TN DME Supplier - Prosthetic Personnel 7911964028 Practice locations: Memphis, TN

Other NPIs with the same Medicare PAC ID 3

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

Medicare medical equipment & supply locations

SupplierSuppliesMedicare assignment
Fourroux Prosthetics6740 Reese Rd, Memphis, TN 38133-4978(901) 383-1827 Limb Prostheses Accepts assignmentParticipating since Jan 1, 2005

National Provider Directory

National Provider Directory
Tax ID family
Fourroux Brace Shoe C4 organizations share this tax ID, including this one

Other organizations with this tax ID 3

Organizations that report the same tax identification number in the National Provider Directory.

Ownership & related parties

Subparts reporting this organization as parent 1

Organizations that report themselves as subparts in NPPES and name this organization, in the same state, as their parent.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1171843200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1591920000000",
    "number": "1386788636",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2743 BOB WALLACE AVE SW",
            "city": "HUNTSVILLE",
            "state": "AL",
            "postal_code": "35805",
            "telephone_number": "256-534-8672",
            "fax_number": "800-963-5010"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6740 REESE ROAD",
            "city": "MEMPHIS",
            "state": "TN",
            "postal_code": "381334978",
            "telephone_number": "901-383-1837",
            "fax_number": "800-963-5010"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FOURROUX PROSTHETICS, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-19",
        "last_updated": "2020-06-12",
        "certification_date": "2020-06-12",
        "status": "A",
        "authorized_official_last_name": "WATSON",
        "authorized_official_first_name": "W",
        "authorized_official_middle_name": "KEITH",
        "authorized_official_title_or_position": "OWNER/PRESIDENT",
        "authorized_official_telephone_number": "256-534-8672",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "CPO"
    },
    "taxonomies": [
        {
            "code": "335E00000X",
            "taxonomy_group": "",
            "desc": "Prosthetic/Orthotic Supplier",
            "state": "TN",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1530932",
            "state": "TN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS OF TENNESSEE",
            "identifier": "4336479",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Memphis, TN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 12, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.