Provider Demographics
NPI:1437334976
Name:JOHN R PIERCE JR.
Entity Type:Organization
Organization Name:JOHN R PIERCE JR.
Other - Org Name:ADVANCED BRACE, LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MS
Authorized Official - First Name:KAY
Authorized Official - Middle Name:
Authorized Official - Last Name:KALIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-882-0142
Mailing Address - Street 1:PO BOX 2286
Mailing Address - Street 2:
Mailing Address - City:LEAGUE CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77574
Mailing Address - Country:US
Mailing Address - Phone:713-882-0142
Mailing Address - Fax:281-334-6244
Practice Address - Street 1:107 WESTWAY
Practice Address - Street 2:#13
Practice Address - City:LAKE JACKSON
Practice Address - State:TX
Practice Address - Zip Code:77566
Practice Address - Country:US
Practice Address - Phone:979-299-0005
Practice Address - Fax:979-299-0008
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-03
Last Update Date:2019-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX101168335E00000X
TX264335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX364531901Medicaid
TX1203780000Medicare UPIN
TX010721101Medicaid