Provider Demographics
NPI:1265488811
Name:MUILENBURG PROSTHETICS, INC.
Entity Type:Organization
Organization Name:MUILENBURG PROSTHETICS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:TED
Authorized Official - Middle Name:BRUCE
Authorized Official - Last Name:MUILENBURG
Authorized Official - Suffix:
Authorized Official - Credentials:CP
Authorized Official - Phone:713-524-3949
Mailing Address - Street 1:PO BOX 8313
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77288-8313
Mailing Address - Country:US
Mailing Address - Phone:713-524-3949
Mailing Address - Fax:713-524-3915
Practice Address - Street 1:3900 LA BRANCH ST
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77004
Practice Address - Country:US
Practice Address - Phone:713-524-3949
Practice Address - Fax:713-524-3915
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-25
Last Update Date:2011-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX407224P00000X
TX335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
No224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX086146001Medicaid
TX0304790001Medicare ID - Type Unspecified