NPIMap

Organization Active NPI

Fourroux Prosthetics, Inc

  • Prosthetic/Orthotic Supplier
  • Huntsville, AL
National Provider Identifier
1528089604
Registry record updated Dec 26, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Prosthetic/Orthotic SupplierTaxonomy code 335E00000X
License
15 Issued in AL
Legal business name
FOURROUX PROSTHETICS, INC
Practice address
2743 Bob Wallace Ave SW
Huntsville, AL 35805-4103
Phone
(256) 534-8672
Fax
(800) 963-5010
NPI assigned
Jul 22, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 26, 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 15 AL Primary

Addresses

Primary practice location

2743 Bob Wallace Ave SW
Huntsville, AL 35805-4103

Mailing address

2743 Bob Wallace Ave SW
Huntsville, AL 35805-4103
Phone (256) 534-8672

Other identifiers 3

IdentifierTypeStateIssuer
4581402MedicaidTN
000050054MedicaidAL
51050054OtherALBCBS OF ALABAMA

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20100930099252 AL DME Supplier - Prosthetic PersonnelDME Supplier - Orthotic Personnel 7911964028 Practice locations: Huntsville, AL

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 Prosthetics Inc2743 Bob Wallace Ave SW, Huntsville, AL 35805-4103(256) 534-8672 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.

Locations

5453 N 59th St
Tampa, FL 33610
Phone (813) 374-6930

6630 McGinnis Ferry Rd
Johns Creek, GA 30097
Phone (770) 622-9158

NPI Registry JSON

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

{
    "created_epoch": "1153526400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1608940800000",
    "number": "1528089604",
    "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": "358054103",
            "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": "2743 BOB WALLACE AVE SW",
            "city": "HUNTSVILLE",
            "state": "AL",
            "postal_code": "358054103",
            "telephone_number": "256-534-8672",
            "fax_number": "800-963-5010"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FOURROUX PROSTHETICS, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-22",
        "last_updated": "2020-12-26",
        "certification_date": "2020-12-26",
        "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": "AL",
            "license": "15",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4581402",
            "state": "TN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000050054",
            "state": "AL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS OF ALABAMA",
            "identifier": "51050054",
            "state": "AL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Huntsville, AL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 26, 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.