| NPI | 1558006130 |
|---|---|
| Former Legal Business Name | COASTAL PROSTHETICS & ORTHOTICS, LLC |
| Doing Business As | EVERGREEN PROSTHETICS AND ORTHOTICS |
| Entity Type | Organization |
| Authorized Contact | JOSEPH HUNTSMAN President 423-736-7976 |
| Organization Subpart ? | No |
| Primary Taxonomy | 335E00000X Prosthetic/Orthotic Supplier |
| Additional Taxonomies | 332BC3200X Durable Medical Equipment & Medical Supplies, Customized Equipment |
| Enumeration Date | 2022-04-28 |
| Last Update Date | 2022-11-11 |