Provider Demographics
NPI:1679748131
Name:NEAL'S PROSTHETICS, INC.
Entity Type:Organization
Organization Name:NEAL'S PROSTHETICS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/PROSTHETIST
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:L
Authorized Official - Last Name:NEAL
Authorized Official - Suffix:
Authorized Official - Credentials:BS,CP, LP
Authorized Official - Phone:903-595-2229
Mailing Address - Street 1:701 TURTLE CREEK DR
Mailing Address - Street 2:
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75701-1834
Mailing Address - Country:US
Mailing Address - Phone:903-595-2229
Mailing Address - Fax:903-595-0138
Practice Address - Street 1:701 TURTLE CREEK DR
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75701-1834
Practice Address - Country:US
Practice Address - Phone:903-595-2229
Practice Address - Fax:903-595-0138
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-25
Last Update Date:2008-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX507335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX087140201Medicaid
TX0372620001Medicare NSC