BUCKNER PROSTHETIC AND ORTHOTIC LABORATORIES INC. (NPI# 1427042134) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1427042134 |
| Entity Type | Organization |
| Organization Name | BUCKNER PROSTHETIC AND ORTHOTIC LABORATORIES INC. |
| Practice Address |
2 Old River Pl Suite D Jackson MS 39202-3435 |
| Practice Telephone | 6019441130 |
| Practice Fax Number | 6013557476 |
| Mailing Telephone | 6019441130 |
| Mailing Fax Number | 6013557476 |
| Enumeration Date | 2005-09-08 |
| Last Update Date | 2013-10-04 |
| Authorized Official Name | MR. MARTIN L BUCKNER (OWNER) |
| Authorized Official Telephone | 6019441130 |
| Authorized Official Credential | C.P.O. |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 224P00000X | Prosthetist | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | ||
| Y | 222Z00000X | Orthotist | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MS | 00040395 | 05 |
| Street Address |
2 OLD RIVER PL SUITE D |
| City | JACKSON |
| State | MS |
| Zip Code | 39202-3435 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1407305030 | Medfusion, LLC | Portable X-ray and/or Other Portable Diagnostic Imaging Supplier | 2 Old River Pl, Suite C, Jackson, MS 39202-3435 | 2016-09-23 |
| 1861830937 | Singleton and Myrick Incorporated | Prosthetic/Orthotic Supplier | 2 Old River Pl, Suite D, Jackson, MS 39202-3435 | 2013-06-11 |
| 1871887653 | Stephen James Singleton | Prosthetist | 2 Old River Pl, Suite D, Jackson, MS 39202-3435 | 2011-06-08 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1982234183 | Eva Mackenzie Carmody | Physician Assistant | 1190 N State St Suite 502, Jackson, MS 39202 | 2020-01-16 |
| 1750868691 | Katherine Walters | Nurse Practitioner | 501 Marshall St., Suite 400, Jackson, MS 39202 | 2018-07-24 |
| 1932638749 | Tylan Lee | Social Worker | 860 East River Place Suite 100, Jackson, MS 39202 | 2017-06-06 |
| 1417314725 | Euna Jyles | Counselor | 860 E River Pl, Jackson, MS 39202 | 2016-01-19 |
| 1255712048 | Edward Jonathan Breight | Specialist/Technologist | 1325 East Fortication Street, Jackson, MS 39202 | 2015-06-17 |
| 1881037703 | Kara Spinks Logan | Surgery | 1190 N State St Ste 502, Jackson, MS 39202 | 2013-04-10 |
| 1477876530 | Mick Inc. | Technician | 334 Josanna Street, Suite #209, Jackson, MS 39202 | 2010-03-03 |
| 1073724910 | Paul Frederic Dare | Anesthesiology | 1151 North State St., Suite 311, Jackson Anesthesia Associates, Jackson, MS 39202 | 2007-05-24 |
| 1225247703 | Lynn Kincannon Holland | Counselor | 911 Manship Street, Unit A, Jackson, MS 39202 | 2007-05-22 |
| 1457568149 | Incare Inc | Pulmonary Function Technologist | 1151 North State St, Suite 406, Jackson, MS 39202 | 2007-05-16 |
| Find all providers in zip 39202 | ||||
| Taxonomy Code | 222Z00000X |
| Grouping | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
| Classification | Orthotist |
| A health care professional who is specifically educated and trained to manage comprehensive orthotic patient care, including musculoskeletal and neuromuscular anomalies resulting from injuries or disease processes involving the lower extremity, upper extremity or spinal segment/s and positional deformation of the cranium. Orthotists assess specific patient needs, formulate an appropriate treatment plan, implement the treatment plan and provide follow-up care. |
| Notes: Source: American Board for Certification in Orthotics, Prosthetics, and Pedorthics, Inc. [7/1/2010: modified, 7/1/2013: modified] Additional Resources: American Board for Certification in Orthotics, Prosthetics and Pedorthics, Inc., www.abcop.org and Board of Certification/Accreditation, International, www.bocusa.org. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1003338898 | Joshua Paul Ahlstrom | Orthotist | 1407 E Michigan Ave, Jackson, MI 49202-3517 | 2017-07-12 |
| 1477894848 | Duane R Hoeppner | Orthotist | 1005 E Michigan Ave, Jackson, MI 49201-2405 | 2013-03-11 |
| 1538258736 | Rick A Psonak | Orthotist | 777 Lakeland Dr, Jackson, MS 39216-4611 | 2006-10-12 |
| 1184149551 | David Trevisan | Orthotist | 1407 E Michigan Ave, Jackson, MI 49202-3517 | 2017-08-07 |
| 1497126775 | Damon Bagley-ayres | Orthotist | 777 Lakeland Dr, Jackson, MS 39216-4611 | 2015-10-13 |
| 1588035257 | Stephen Bret Lee | Orthotist | 2500 N State St, Jackson, MS 39216-4500 | 2015-10-07 |
| 1417362849 | Amy R Adcox | Orthotist | 2500 N State St, Jackson, MS 39216-4500 | 2014-06-24 |
| 1679916183 | Zachary Douglas Myrick | Orthotist | 2 Old River Pl Ste D, Jackson, MS 39202-3435 | 2013-04-15 |
| 1548583172 | Charles Reggie Kennedy Sr. | Orthotist | 777 Lakeland Dr, Jackson, MS 39216-4611 | 2010-03-10 |
| 1952586786 | Kevin Scribner | Orthotist | 2500 N State St, Jackson, MS 39216-4500 | 2007-12-28 |
| Find all providers in JACKSON | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.