Provider Demographics
NPI:1336186162
Name:NUTECH ORTHOTICS & PROSTHETICS, LLC
Entity Type:Organization
Organization Name:NUTECH ORTHOTICS & PROSTHETICS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER, MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DOUGLASS
Authorized Official - Middle Name:J
Authorized Official - Last Name:WACKER
Authorized Official - Suffix:
Authorized Official - Credentials:CPO, LPO
Authorized Official - Phone:956-412-5347
Mailing Address - Street 1:501 N ED CAREY DR
Mailing Address - Street 2:STE A
Mailing Address - City:HARLINGEN
Mailing Address - State:TX
Mailing Address - Zip Code:78550-8358
Mailing Address - Country:US
Mailing Address - Phone:956-412-5347
Mailing Address - Fax:956-412-3563
Practice Address - Street 1:501 N ED CAREY DR
Practice Address - Street 2:STE A
Practice Address - City:HARLINGEN
Practice Address - State:TX
Practice Address - Zip Code:78550-8358
Practice Address - Country:US
Practice Address - Phone:956-412-5347
Practice Address - Fax:956-412-3563
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-01
Last Update Date:2010-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX85335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX172779404Medicaid
TX172779401Medicaid
TX179772403Medicaid
TX179772402Medicaid
TX179772402Medicaid