Provider Demographics
NPI:1073756292
Name:SPECIALTY PROSTHETIC & ORTHOTICS OF TEXAS
Entity Type:Organization
Organization Name:SPECIALTY PROSTHETIC & ORTHOTICS OF TEXAS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:
Authorized Official - Last Name:KHU
Authorized Official - Suffix:
Authorized Official - Credentials:CPO/LPO
Authorized Official - Phone:210-932-3000
Mailing Address - Street 1:98 BRIGGS ST
Mailing Address - Street 2:SUITE 950
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78224-1286
Mailing Address - Country:US
Mailing Address - Phone:210-932-3000
Mailing Address - Fax:210-932-3040
Practice Address - Street 1:2222 WESTERN TRAILS BLVD
Practice Address - Street 2:SUITE 102
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78745-1682
Practice Address - Country:US
Practice Address - Phone:512-826-7830
Practice Address - Fax:210-932-3040
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SPECIALTY PROSTHETIC & ORTHOTICS OF TEXS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-04-17
Last Update Date:2009-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX156537602Medicaid
TX156537601Medicaid
TX4720840001Medicare NSC