Provider Demographics
NPI:1588919047
Name:BULOW PROVIDER NETWORK, LLC
Entity type:Organization
Organization Name:BULOW PROVIDER NETWORK, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:VP OF FINANCE AND CLINIC OPS
Authorized Official - Prefix:
Authorized Official - First Name:BRAD
Authorized Official - Middle Name:
Authorized Official - Last Name:GARDNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-550-8774
Mailing Address - Street 1:102 WOODMONT BLVD
Mailing Address - Street 2:SUITE 120
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37205-2287
Mailing Address - Country:US
Mailing Address - Phone:615-550-8774
Mailing Address - Fax:615-454-5352
Practice Address - Street 1:1601 E 19TH AVE
Practice Address - Street 2:SUITE 5200
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80218-1216
Practice Address - Country:US
Practice Address - Phone:615-550-8774
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BULOW BIOTECH PROSTHETICS, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-07-19
Last Update Date:2014-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty