Provider Demographics
NPI:1619428695
Name:MATISONS ORTHOTICS-PROSTHETICS
Entity Type:Organization
Organization Name:MATISONS ORTHOTICS-PROSTHETICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FRONT DESK
Authorized Official - Prefix:
Authorized Official - First Name:MARI
Authorized Official - Middle Name:M
Authorized Official - Last Name:GARCIA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:361-441-3130
Mailing Address - Street 1:3560 S ALAMEDA ST STE 2
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78411-1736
Mailing Address - Country:US
Mailing Address - Phone:361-854-5200
Mailing Address - Fax:361-854-7626
Practice Address - Street 1:3560 S ALAMEDA ST STE 2
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78411-1736
Practice Address - Country:US
Practice Address - Phone:361-854-5200
Practice Address - Fax:361-854-7626
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-14
Last Update Date:2016-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies