Provider Demographics
NPI:1134598527
Name:TGG PROSTHETICS AND ORTHOTICS, LLC
Entity type:Organization
Organization Name:TGG PROSTHETICS AND ORTHOTICS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER / PROSTHETIST / ORTHOTIST
Authorized Official - Prefix:MR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:FOSTER
Authorized Official - Suffix:
Authorized Official - Credentials:CPO
Authorized Official - Phone:405-514-8774
Mailing Address - Street 1:125 E 3RD ST
Mailing Address - Street 2:SUITE C
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73034-3821
Mailing Address - Country:US
Mailing Address - Phone:405-514-8774
Mailing Address - Fax:
Practice Address - Street 1:125 E 3RD ST
Practice Address - Street 2:SUITE C
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73034-3821
Practice Address - Country:US
Practice Address - Phone:405-514-8774
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-16
Last Update Date:2015-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKLO 39335E00000X
OKLP 39335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier