Provider Demographics
NPI:1114926888
Name:PROCARE ORTHOTICS & PROSTHETICS INC
Entity Type:Organization
Organization Name:PROCARE ORTHOTICS & PROSTHETICS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:BILL
Authorized Official - Middle Name:E
Authorized Official - Last Name:HEARN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-799-1000
Mailing Address - Street 1:1311 PRINCE CREEK CT
Mailing Address - Street 2:
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77450-4924
Mailing Address - Country:US
Mailing Address - Phone:713-799-1000
Mailing Address - Fax:713-799-1260
Practice Address - Street 1:11261 RICHMOND AVE STE 101
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77082-2676
Practice Address - Country:US
Practice Address - Phone:713-799-1000
Practice Address - Fax:713-799-1260
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-15
Last Update Date:2021-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX56174400000X
TX101038332B00000X, 335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
No174400000XOther Service ProvidersSpecialistGroup - Single Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX143674301Medicaid
TX530861OtherBLUECROSS BLUESHIELD ID#
TX143674301Medicaid