Provider Demographics
NPI:1952463424
Name:PRESCOTT LIMB & BRACES INC
Entity Type:Organization
Organization Name:PRESCOTT LIMB & BRACES INC
Other - Org Name:PRESCOTTS AUSTIN 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:WAYNE
Authorized Official - Last Name:PRESCOTT
Authorized Official - Suffix:
Authorized Official - Credentials:CO
Authorized Official - Phone:512-452-6479
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 1:3906 N LAMAR BLVD
Practice Address - Street 2:STE 100
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78756-4000
Practice Address - Country:US
Practice Address - Phone:512-452-6479
Practice Address - Fax:512-452-3222
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-14
Last Update Date:2007-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX101008335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0401610006Medicare NSC