1336220607 NPI number — HEDGECOCK ARTIFICIAL LIMB CO., INC.

Table of content: (NPI 1336220607)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1336220607 NPI number — HEDGECOCK ARTIFICIAL LIMB CO., INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HEDGECOCK ARTIFICIAL LIMB CO., INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1336220607
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/24/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6500 GREENVILLE AVE
Provider Second Line Business Mailing Address:
STE 195
Provider Business Mailing Address City Name:
DALLAS
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75206-1014
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
214-360-9700
Provider Business Mailing Address Fax Number:
214-360-9713

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6500 GREENVILLE AVE
Provider Second Line Business Practice Location Address:
STE 195
Provider Business Practice Location Address City Name:
DALLAS
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75206-1014
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
214-360-9700
Provider Business Practice Location Address Fax Number:
214-360-9713
Provider Enumeration Date:
10/17/2006

Additional Information

Authorized Official

Authorized Official Last Name:
CICERO
Authorized Official First Name:
ANN
Authorized Official Middle Name:
Authorized Official Title or Position:
CHAIRMAN OF BOARD/PRESIDENT
Authorized Official Telephone Number:
214-360-9700

Provider Taxonomy Codes

  • Taxonomy code: 335E00000X , with the licence number:  000050 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0000500051 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 0861296-01 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com