1265766018 NPI number — TEXAS ORTHOTICS INC

Table of content: (NPI 1265766018)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1265766018 NPI number — TEXAS ORTHOTICS INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TEXAS ORTHOTICS 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:
6
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:
1265766018
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/06/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2382 FARADAY AVENUE
Provider Second Line Business Mailing Address:
SUITE 300
Provider Business Mailing Address City Name:
CARLSBAD
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92008-7220
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
760-795-5440
Provider Business Mailing Address Fax Number:
214-501-0299

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2380 DEAN WAY
Provider Second Line Business Practice Location Address:
SUITE 140
Provider Business Practice Location Address City Name:
SOUTHLAKE
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
76092-1379
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
817-416-7400
Provider Business Practice Location Address Fax Number:
800-454-9615
Provider Enumeration Date:
09/28/2009

Additional Information

Authorized Official

Authorized Official Last Name:
MOWRY
Authorized Official First Name:
DAVE
Authorized Official Middle Name:
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
760-795-5440

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 335E00000X , with the licence number: 101306 , 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: 151548801 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 151547001 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




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