Provider Demographics
NPI:1578563193
Name:LEDDY BRACE & SHOE INC
Entity Type:Organization
Organization Name:LEDDY BRACE & SHOE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ORTHOTIST PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:RAYMOND
Authorized Official - Middle Name:ARDELL
Authorized Official - Last Name:BLASINGAME
Authorized Official - Suffix:
Authorized Official - Credentials:CPED LO
Authorized Official - Phone:325-673-5281
Mailing Address - Street 1:932 N TREADAWAY BLVD
Mailing Address - Street 2:
Mailing Address - City:ABILENE
Mailing Address - State:TX
Mailing Address - Zip Code:79601-4315
Mailing Address - Country:US
Mailing Address - Phone:325-673-5281
Mailing Address - Fax:325-673-5282
Practice Address - Street 1:932 N TREADAWAY BLVD
Practice Address - Street 2:
Practice Address - City:ABILENE
Practice Address - State:TX
Practice Address - Zip Code:79601-4315
Practice Address - Country:US
Practice Address - Phone:325-673-5281
Practice Address - Fax:325-673-5282
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-26
Last Update Date:2013-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX000055332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX519252OtherBLUE CROSS BLUE SHIELD OF
TX010138801Medicaid
TX0977410001Medicare ID - Type UnspecifiedPALMETTO GBA