Provider Demographics
NPI:1962685149
Name:ACME ORTHOPEDIC LABS, LLC
Entity Type:Organization
Organization Name:ACME ORTHOPEDIC LABS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHEY
Authorized Official - Middle Name:
Authorized Official - Last Name:CAMPBELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:210-655-5227
Mailing Address - Street 1:2411 NE LOOP 410 STE 112
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78217-6600
Mailing Address - Country:US
Mailing Address - Phone:210-655-5227
Mailing Address - Fax:210-646-0585
Practice Address - Street 1:2411 NE LOOP 410 STE 112
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78217-6600
Practice Address - Country:US
Practice Address - Phone:210-655-5227
Practice Address - Fax:210-646-0585
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-11
Last Update Date:2007-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX0078720332B00000X
TX101148335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
531866OtherBLUE CROSS BLUE SHIELD