Provider Demographics
NPI:1679635130
Name:PRESCOTT'S LIMBS & BRACES
Entity Type:Organization
Organization Name:PRESCOTT'S LIMBS & BRACES
Other - Org Name:PRESCOTT'S ORTHOTICS & PROSTHETICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:W
Authorized Official - Last Name:PRESCOTT
Authorized Official - Suffix:
Authorized Official - Credentials:CPO
Authorized Official - Phone:210-224-0726
Mailing Address - Street 1:6715 SAN PEDRO AVE
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78216-7218
Mailing Address - Country:US
Mailing Address - Phone:210-224-0726
Mailing Address - Fax:210-341-3164
Practice Address - Street 1:158 E. SONTERRA BLVD
Practice Address - Street 2:STE. 106
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78258-4097
Practice Address - Country:US
Practice Address - Phone:210-496-0800
Practice Address - Fax:210-496-0801
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-14
Last Update Date:2009-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0401610010Medicare NSC