Provider Demographics
NPI:1477596724
Name:THE BRACE PLACE INC.
Entity Type:Organization
Organization Name:THE BRACE PLACE INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ORTHOTIST/PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:LADD
Authorized Official - Last Name:SPRADLING
Authorized Official - Suffix:
Authorized Official - Credentials:CO
Authorized Official - Phone:806-792-0395
Mailing Address - Street 1:3719 24TH ST
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79410-2015
Mailing Address - Country:US
Mailing Address - Phone:806-792-0395
Mailing Address - Fax:806-792-0396
Practice Address - Street 1:3719 24TH ST
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79410-2015
Practice Address - Country:US
Practice Address - Phone:806-792-0395
Practice Address - Fax:806-792-0396
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-14
Last Update Date:2012-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX0011332B00000X, 335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX010018201Medicaid
TX106490100OtherFIRSTCARE
TX519091OtherBLUE CROSS BLUE SHIELD
NMR3872OtherNM MEDICAID (CONSULTEC)
TX519091OtherBLUE CROSS BLUE SHIELD