1861878910 NPI number — LAREDO PROSTHETICS, INC.

Table of content: BREANNE SHRUM PTA, CFO (NPI 1144747189)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1861878910 NPI number — LAREDO PROSTHETICS, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LAREDO PROSTHETICS, 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:
1861878910
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/30/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 249
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BELLAIRE
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77402-0249
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
956-523-0450
Provider Business Mailing Address Fax Number:
956-523-0448

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10410 MEDICAL LOOP BLDG 5
Provider Second Line Business Practice Location Address:
SUITE 5C
Provider Business Practice Location Address City Name:
LAREDO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78045-6671
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
956-523-0450
Provider Business Practice Location Address Fax Number:
956-523-0448
Provider Enumeration Date:
07/30/2015

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
NELSON
Authorized Official First Name:
SCHUYLER
Authorized Official Middle Name:
Z
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
214-770-4161

Provider Taxonomy Codes

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

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