Provider Demographics
NPI:1508296021
Name:PROSTHETIC SOLUTION CENTERS OF AMERICA, LLC
Entity Type:Organization
Organization Name:PROSTHETIC SOLUTION CENTERS OF AMERICA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:MR
Authorized Official - First Name:DALE
Authorized Official - Middle Name:STUART LEE
Authorized Official - Last Name:SHEEN
Authorized Official - Suffix:
Authorized Official - Credentials:LPO
Authorized Official - Phone:281-580-8228
Mailing Address - Street 1:PO BOX 90939
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77290-0939
Mailing Address - Country:US
Mailing Address - Phone:713-790-1185
Mailing Address - Fax:713-790-1197
Practice Address - Street 1:1417 S LOOP W
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77054-3815
Practice Address - Country:US
Practice Address - Phone:713-790-1185
Practice Address - Fax:713-790-1197
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-19
Last Update Date:2019-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier