1659483725 NPI number — CENTRAL TEXAS ORTHOTICS & PROSTHETICS, LP

Table of content: (NPI 1659483725)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1659483725 NPI number — CENTRAL TEXAS ORTHOTICS & PROSTHETICS, LP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CENTRAL TEXAS ORTHOTICS & PROSTHETICS, LP
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:
HANGER CLINIC
Provider Other Organization Name Type Code:
3
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:
1659483725
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/08/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 650846
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DALLAS
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75265-0846
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2112 E VILLA MARIA RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BRYAN
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77802-2542
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
979-731-1985
Provider Business Practice Location Address Fax Number:
979-776-8447
Provider Enumeration Date:
08/31/2006

Additional Information

Authorized Official

Authorized Official Last Name:
ANGELINE
Authorized Official First Name:
GRACE
Authorized Official Middle Name:
Authorized Official Title or Position:
REG COMPLIANCE SPECIALIST IV
Authorized Official Telephone Number:
714-961-2102

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 335E00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 145737601 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000140 . This is a "STATE LICENSE-FACILITY" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 22102 . This is a "SCOTT AND WHITE ID" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 515099 . This is a "BCBS PROVIDER ID" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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