Provider Demographics
NPI:1689798050
Name:TMC ORTHOPEDIC, LP
Entity Type:Organization
Organization Name:TMC ORTHOPEDIC, LP
Other - Org Name:TMC BRACE PLACE SOUTHWEST
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:E
Authorized Official - Last Name:MATTHEWS
Authorized Official - Suffix:V
Authorized Official - Credentials:
Authorized Official - Phone:713-669-1800
Mailing Address - Street 1:1000 SOUTH LOOP WEST
Mailing Address - Street 2:SUITE150
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77054-4658
Mailing Address - Country:US
Mailing Address - Phone:713-669-1800
Mailing Address - Fax:713-669-8330
Practice Address - Street 1:7320 US HIGHWAY 90A
Practice Address - Street 2:SUITE 150
Practice Address - City:SUGAR LAND
Practice Address - State:TX
Practice Address - Zip Code:77478-3355
Practice Address - Country:US
Practice Address - Phone:281-242-2118
Practice Address - Fax:281-242-2119
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TMC ORTHOPEDIC LP
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-03-19
Last Update Date:2011-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X
TX0040104332BC3200X
TX101320335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX111396102Medicaid
TX017102701Medicaid
TX0425250002Medicare NSC