Provider Demographics
NPI:1336398270
Name:R M D & K INC,
Entity Type:Organization
Organization Name:R M D & K INC,
Other - Org Name:CENTRAL PROSTHETICS AND ORTHOTICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KATHY
Authorized Official - Middle Name:BRADSHAW
Authorized Official - Last Name:AVERITT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:254-776-5533
Mailing Address - Street 1:7724 CENTRAL PARK DR
Mailing Address - Street 2:
Mailing Address - City:WACO
Mailing Address - State:TX
Mailing Address - Zip Code:76712-6535
Mailing Address - Country:US
Mailing Address - Phone:254-776-5533
Mailing Address - Fax:254-776-5590
Practice Address - Street 1:2626 S 37TH ST STE 104
Practice Address - Street 2:
Practice Address - City:TEMPLE
Practice Address - State:TX
Practice Address - Zip Code:76504-7136
Practice Address - Country:US
Practice Address - Phone:254-742-2771
Practice Address - Fax:254-773-5363
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-16
Last Update Date:2017-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX101170335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX24099OtherSCOTT AND WHITE
TX091572001Medicaid
519417OtherBCBS
TX24099OtherSCOTT AND WHITE
102770100OtherFIRST CARE