Provider Demographics
NPI:1780201079
Name:LAZY J BAR D, LLC
Entity Type:Organization
Organization Name:LAZY J BAR D, LLC
Other - Org Name:CAPSTONE ORTHOTICS AND PROSTHETICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JASON
Authorized Official - Middle Name:MANSFIELD
Authorized Official - Last Name:JENNINGS
Authorized Official - Suffix:
Authorized Official - Credentials:CPO
Authorized Official - Phone:713-397-9558
Mailing Address - Street 1:106 PECAN DR
Mailing Address - Street 2:
Mailing Address - City:FRIENDSWOOD
Mailing Address - State:TX
Mailing Address - Zip Code:77546-3828
Mailing Address - Country:US
Mailing Address - Phone:713-397-9558
Mailing Address - Fax:833-915-0204
Practice Address - Street 1:106 PECAN DR
Practice Address - Street 2:
Practice Address - City:FRIENDSWOOD
Practice Address - State:TX
Practice Address - Zip Code:77546-3828
Practice Address - Country:US
Practice Address - Phone:713-397-9558
Practice Address - Fax:833-915-0204
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-02
Last Update Date:2021-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes335E00000XSuppliersProsthetic/Orthotic SupplierGroup - Single Specialty
No224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetistGroup - Single Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies