Provider Demographics
NPI:1679087654
Name:PATELLA MEDICAL, INC
Entity type:Organization
Organization Name:PATELLA MEDICAL, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:KATHLEEN
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:GUC
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:800-215-1452
Mailing Address - Street 1:4 BRADLEY PARK CT STE 1B
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31904-3636
Mailing Address - Country:US
Mailing Address - Phone:800-215-1452
Mailing Address - Fax:
Practice Address - Street 1:4 BRADLEY PARK CT STE 1B
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31904-3636
Practice Address - Country:US
Practice Address - Phone:800-215-1452
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-28
Last Update Date:2017-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies