Provider Demographics
NPI:1407854854
Name:SOUTH TEXAS PROSTHETICS INC
Entity Type:Organization
Organization Name:SOUTH TEXAS PROSTHETICS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JACK
Authorized Official - Middle Name:B
Authorized Official - Last Name:ROSENBERGER
Authorized Official - Suffix:
Authorized Official - Credentials:CP
Authorized Official - Phone:210-377-1234
Mailing Address - Street 1:302 E NAKOMA ST
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78216-2732
Mailing Address - Country:US
Mailing Address - Phone:210-377-1234
Mailing Address - Fax:210-308-0210
Practice Address - Street 1:302 E NAKOMA ST
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78216-2732
Practice Address - Country:US
Practice Address - Phone:210-377-1234
Practice Address - Fax:210-308-0210
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-11
Last Update Date:2008-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX000098335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
V671P3887OtherVETERANS ADMINISTRATING
0411770001Medicare NSC