Provider Demographics
NPI:1982651261
Name:CHAD EDWARD MASON
Entity Type:Organization
Organization Name:CHAD EDWARD MASON
Other - Org Name:AMARILLO ARTIFICIAL LIMB AND BRACE CO.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER, ORTHOTIST, PROSTHETIST
Authorized Official - Prefix:MR
Authorized Official - First Name:CHAD
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:MASON
Authorized Official - Suffix:
Authorized Official - Credentials:CPO, LPO
Authorized Official - Phone:806-331-0350
Mailing Address - Street 1:713 N TAYLOR ST
Mailing Address - Street 2:
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79107-5279
Mailing Address - Country:US
Mailing Address - Phone:806-331-0350
Mailing Address - Fax:806-331-0353
Practice Address - Street 1:713 N TAYLOR ST
Practice Address - Street 2:
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79107-5279
Practice Address - Country:US
Practice Address - Phone:806-331-0350
Practice Address - Fax:806-331-0353
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-30
Last Update Date:2007-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX130335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX3118490001Medicare NSC
TX3875710001Medicare NSC