Provider Demographics
NPI:1053395780
Name:STUBBS PROSTHETICS & ORTHOTICS, INC.
Entity type:Organization
Organization Name:STUBBS PROSTHETICS & ORTHOTICS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:MELANIE
Authorized Official - Middle Name:
Authorized Official - Last Name:STUBBS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:423-698-1778
Mailing Address - Street 1:5715 UPTAIN RD
Mailing Address - Street 2:SUITE 5800
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37411-5511
Mailing Address - Country:US
Mailing Address - Phone:423-698-1778
Mailing Address - Fax:423-698-1741
Practice Address - Street 1:5715 UPTAIN RD
Practice Address - Street 2:SUITE 5800
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37411-5511
Practice Address - Country:US
Practice Address - Phone:423-698-1778
Practice Address - Fax:423-698-1741
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-06
Last Update Date:2019-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3541423Medicaid
GA000244483AOtherMEDICAID
TN15523OtherBCBST
GA000244483AOtherMEDICAID