NPIMap

Organization Active NPI

Petties & Associates Orthotic / Prosthetics, LLC

  • Prosthetic/Orthotic Supplier
  • Memphis, TN
National Provider Identifier
1780900852
Registry record updated Dec 22, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Prosthetic/Orthotic SupplierTaxonomy code 335E00000X
License
188 / 230 Issued in TN
Legal business name
PETTIES & ASSOCIATES ORTHOTIC / PROSTHETICS, LLC
Practice address
1089 Eastmoreland Ave
Memphis, TN 38104-3334
Phone
(901) 275-8358
Fax
(901) 525-9378
NPI assigned
Apr 14, 2010
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 22, 2011

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

Authorized official

Name
Otis V. Petties Sr., CPO/FAAOP
Title
President
Phone
(901) 270-5470

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Prosthetic/Orthotic Supplier 335E00000X 188 / 230 TN Primary

Addresses

Primary practice location

1089 Eastmoreland Ave
Memphis, TN 38104-3334

Mailing address

1089 Eastmoreland Ave
Memphis, TN 38104-3334
Phone (901) 275-8358

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1271203200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1324512000000",
    "number": "1780900852",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1089 EASTMORELAND AVE",
            "city": "MEMPHIS",
            "state": "TN",
            "postal_code": "381043334",
            "telephone_number": "901-275-8358",
            "fax_number": "901-525-9378"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1089 EASTMORELAND AVE",
            "city": "MEMPHIS",
            "state": "TN",
            "postal_code": "381043334",
            "telephone_number": "901-275-8358",
            "fax_number": "901-525-9378"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PETTIES & ASSOCIATES ORTHOTIC / PROSTHETICS, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-04-14",
        "last_updated": "2011-12-22",
        "status": "A",
        "authorized_official_last_name": "PETTIES",
        "authorized_official_first_name": "OTIS",
        "authorized_official_middle_name": "V.",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "901-270-5470",
        "authorized_official_name_suffix": "Sr.",
        "authorized_official_credential": "CPO/FAAOP"
    },
    "taxonomies": [
        {
            "code": "335E00000X",
            "taxonomy_group": "",
            "desc": "Prosthetic/Orthotic Supplier",
            "state": "TN",
            "license": "188 / 230",
            "primary": true
        }
    ],
    "identifiers": [],
    "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 Dec 22, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.