Provider Demographics
NPI:1356610562
Name:TEXAS ELITE CARE ORTHOTICS & PROSTHETICS LLC
Entity type:Organization
Organization Name:TEXAS ELITE CARE ORTHOTICS & PROSTHETICS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EMPLOYEE
Authorized Official - Prefix:MR
Authorized Official - First Name:JESSE
Authorized Official - Middle Name:
Authorized Official - Last Name:ANDRADE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:7138-613-3337
Mailing Address - Street 1:1919 NORTH LOOP WEST
Mailing Address - Street 2:SUITE 140
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77008
Mailing Address - Country:US
Mailing Address - Phone:713-861-3337
Mailing Address - Fax:713-861-3342
Practice Address - Street 1:1919 NORTH LOOP WEST
Practice Address - Street 2:SUITE 140
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77008
Practice Address - Country:US
Practice Address - Phone:713-861-3337
Practice Address - Fax:713-861-3342
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-16
Last Update Date:2012-12-14
Deactivation Date:2012-10-24
Deactivation Code:
Reactivation Date:2012-11-07
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1744P3200XOther Service ProvidersSpecialistProsthetics Case ManagementGroup - Single Specialty