Provider Demographics
NPI:1275675035
Name:CALDWELL PROSTHETICS AND ORTHOTICS, LLC
Entity Type:Organization
Organization Name:CALDWELL PROSTHETICS AND ORTHOTICS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:GLENN
Authorized Official - Last Name:CALDWELL
Authorized Official - Suffix:
Authorized Official - Credentials:CPO
Authorized Official - Phone:972-375-3892
Mailing Address - Street 1:330 INDUSTRIAL BLVD
Mailing Address - Street 2:SUITE 110
Mailing Address - City:MCKINNEY
Mailing Address - State:TX
Mailing Address - Zip Code:75069-7305
Mailing Address - Country:US
Mailing Address - Phone:972-548-7707
Mailing Address - Fax:972-548-7739
Practice Address - Street 1:330 INDUSTRIAL BLVD
Practice Address - Street 2:110
Practice Address - City:MCKINNEY
Practice Address - State:TX
Practice Address - Zip Code:75069-7305
Practice Address - Country:US
Practice Address - Phone:972-548-7707
Practice Address - Fax:972-548-7739
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-12
Last Update Date:2008-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 332BC3200X
TX1224335E00000X
TX101229335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX5905440001Medicare NSC