Provider Demographics
NPI:1033279310
Name:ORTHOPEDIC SPECIALISTS, D.M.E.,INC
Entity Type:Organization
Organization Name:ORTHOPEDIC SPECIALISTS, D.M.E.,INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:JEANETTE
Authorized Official - Middle Name:CROUT
Authorized Official - Last Name:GARCIA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:361-881-9696
Mailing Address - Street 1:2222 MORGAN AVE STE 106
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78405-1900
Mailing Address - Country:US
Mailing Address - Phone:361-881-9696
Mailing Address - Fax:361-888-8575
Practice Address - Street 1:2222 MORGAN AVE STE 106
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78405-1900
Practice Address - Country:US
Practice Address - Phone:361-881-9696
Practice Address - Fax:361-888-8575
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0102410001Medicaid
TX0102410001Medicaid