Provider Demographics
NPI:1780862664
Name:ORTHOTICS PLUS LLC
Entity Type:Organization
Organization Name:ORTHOTICS PLUS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:S
Authorized Official - Last Name:HAVRAN
Authorized Official - Suffix:
Authorized Official - Credentials:CO/LO
Authorized Official - Phone:210-692-1111
Mailing Address - Street 1:2122 BABCOCK RD STE 102
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78229-4411
Mailing Address - Country:US
Mailing Address - Phone:210-692-1111
Mailing Address - Fax:210-692-6041
Practice Address - Street 1:2122 BABCOCK RD STE 102
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-4411
Practice Address - Country:US
Practice Address - Phone:210-692-1111
Practice Address - Fax:210-692-6041
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-04
Last Update Date:2008-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX445335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX176263502Medicaid
TX176263501Medicaid
TX176263503Medicaid
TX176263504Medicaid
TX1780862664Medicare PIN
TX5529920001Medicare NSC