Provider Demographics
NPI:1184824807
Name:TWIN CITY ORTHOTICS & PROSTHETICS, LLC
Entity Type:Organization
Organization Name:TWIN CITY ORTHOTICS & PROSTHETICS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED ORTHOTIST/PROSTHETIST
Authorized Official - Prefix:MR
Authorized Official - First Name:MITCHEL
Authorized Official - Middle Name:E
Authorized Official - Last Name:PRESLEY
Authorized Official - Suffix:JR
Authorized Official - Credentials:LPO
Authorized Official - Phone:936-622-3832
Mailing Address - Street 1:4800 NE STALLINGS DR
Mailing Address - Street 2:STE. 1600
Mailing Address - City:NACOGDOCHES
Mailing Address - State:TX
Mailing Address - Zip Code:75965-1249
Mailing Address - Country:US
Mailing Address - Phone:936-622-3832
Mailing Address - Fax:936-622-3851
Practice Address - Street 1:4800 NE STALLINGS DR
Practice Address - Street 2:STE. 1600
Practice Address - City:NACOGDOCHES
Practice Address - State:TX
Practice Address - Zip Code:75965-1249
Practice Address - Country:US
Practice Address - Phone:936-622-3832
Practice Address - Fax:936-622-3851
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-20
Last Update Date:2008-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX55335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX532691OtherBLUE CROSS & BLUE SHIELD OF TEXAS
TX6042670001Medicare NSC