Provider Demographics
NPI:1336220607
Name:HEDGECOCK ARTIFICIAL LIMB CO., INC.
Entity Type:Organization
Organization Name:HEDGECOCK ARTIFICIAL LIMB CO., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHAIRMAN OF BOARD/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ANN
Authorized Official - Middle Name:
Authorized Official - Last Name:CICERO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-360-9700
Mailing Address - Street 1:6500 GREENVILLE AVE
Mailing Address - Street 2:STE 195
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75206-1014
Mailing Address - Country:US
Mailing Address - Phone:214-360-9700
Mailing Address - Fax:214-360-9713
Practice Address - Street 1:6500 GREENVILLE AVE
Practice Address - Street 2:STE 195
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75206-1014
Practice Address - Country:US
Practice Address - Phone:214-360-9700
Practice Address - Fax:214-360-9713
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-17
Last Update Date:2010-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX000050335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0000500051OtherBLUE CROSS BLUE SHIELD
TX0861296-01Medicaid
TX0861296-01Medicaid