Provider Demographics
NPI:1144296476
Name:TEXAS ORTHOTIC & PROSTHETIC SYSTEMS INC
Entity type:Organization
Organization Name:TEXAS ORTHOTIC & PROSTHETIC SYSTEMS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MGR
Authorized Official - Prefix:MR
Authorized Official - First Name:STUART
Authorized Official - Middle Name:LEIGH
Authorized Official - Last Name:WILLETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-810-0901
Mailing Address - Street 1:1226 SOUTH LAKE ST
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76104
Mailing Address - Country:US
Mailing Address - Phone:817-810-0901
Mailing Address - Fax:817-810-0903
Practice Address - Street 1:1226 SOUTH LAKE ST
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76104
Practice Address - Country:US
Practice Address - Phone:817-810-0901
Practice Address - Fax:817-810-0903
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX101193335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX6491456OtherAETNA
TX10030707OtherAMERI GROUP
TX530908OtherBCBS
TX3917100001Medicare ID - Type Unspecified