Provider Demographics
NPI:1083592364
Name:PROSTHETIC-ORTHOTIC ASSOCIATES OF EAST TEXAS, INC.
Entity type:Organization
Organization Name:PROSTHETIC-ORTHOTIC ASSOCIATES OF EAST TEXAS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BRUCE
Authorized Official - Middle Name:P
Authorized Official - Last Name:MCCLELLAN
Authorized Official - Suffix:
Authorized Official - Credentials:CPO
Authorized Official - Phone:903-592-6574
Mailing Address - Street 1:1028 E IDEL ST
Mailing Address - Street 2:
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75701-2024
Mailing Address - Country:US
Mailing Address - Phone:903-592-6574
Mailing Address - Fax:903-595-3862
Practice Address - Street 1:713 N 4TH ST
Practice Address - Street 2:
Practice Address - City:LONGVIEW
Practice Address - State:TX
Practice Address - Zip Code:75601-5412
Practice Address - Country:US
Practice Address - Phone:430-240-8767
Practice Address - Fax:430-240-4475
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PROSTHETIC-ORTHOTIC ASSOCIATES OF EAST TEXAS, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2025-08-25
Last Update Date:2025-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier