Provider Demographics
NPI:1427036367
Name:ALLEN ORTHOTICS & PROSTHETICS, INC.
Entity Type:Organization
Organization Name:ALLEN ORTHOTICS & PROSTHETICS, INC.
Other - Org Name:ALLEN BRACE COMPANY, WEST TEXAS PROSTHETIC SERVICES
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:FERNANDO
Authorized Official - Middle Name:ESTRADA
Authorized Official - Last Name:ORDAZ
Authorized Official - Suffix:
Authorized Official - Credentials:CPO/LPO
Authorized Official - Phone:432-683-3788
Mailing Address - Street 1:2502 W OHIO AVE
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:TX
Mailing Address - Zip Code:79701-5848
Mailing Address - Country:US
Mailing Address - Phone:432-683-3788
Mailing Address - Fax:432-683-6470
Practice Address - Street 1:1921 E 37TH ST STE A
Practice Address - Street 2:
Practice Address - City:ODESSA
Practice Address - State:TX
Practice Address - Zip Code:79762-6209
Practice Address - Country:US
Practice Address - Phone:432-332-9821
Practice Address - Fax:432-683-6470
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-01
Last Update Date:2020-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX101081335E00000X
TX101421335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
0295330001Medicare NSC