Provider Demographics
NPI:1346302809
Name:PRESCOTTS LIMBS & BRACES INC
Entity Type:Organization
Organization Name:PRESCOTTS LIMBS & BRACES INC
Other - Org Name:PRESCOTTS ORTHOTICS AND PROSTHETICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:WAYNE
Authorized Official - Last Name:PRESCOTT
Authorized Official - Suffix:
Authorized Official - Credentials:CO
Authorized Official - Phone:956-791-1277
Mailing Address - Street 1:6715 SAN PEDRO AVE
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78216-7218
Mailing Address - Country:US
Mailing Address - Phone:210-224-0726
Mailing Address - Fax:210-341-3164
Practice Address - Street 1:1306 N MALINCHE AVE
Practice Address - Street 2:
Practice Address - City:LAREDO
Practice Address - State:TX
Practice Address - Zip Code:78043-3356
Practice Address - Country:US
Practice Address - Phone:956-791-1277
Practice Address - Fax:956-791-1279
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-14
Last Update Date:2019-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX000081335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0112427-01Medicaid