Provider Demographics
NPI:1881921450
Name:TWIN CITY ORTHOTICS & PROSTHETICS OF WACO
Entity type:Organization
Organization Name:TWIN CITY ORTHOTICS & PROSTHETICS OF WACO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:MITCHEL
Authorized Official - Middle Name:EARL
Authorized Official - Last Name:PRESLEY
Authorized Official - Suffix:JR
Authorized Official - Credentials:LPO
Authorized Official - Phone:936-622-3832
Mailing Address - Street 1:6600 SANGER AVE
Mailing Address - Street 2:SUITE 13
Mailing Address - City:WACO
Mailing Address - State:TX
Mailing Address - Zip Code:76710-7814
Mailing Address - Country:US
Mailing Address - Phone:254-751-0266
Mailing Address - Fax:254-751-1083
Practice Address - Street 1:6600 SANGER AVE
Practice Address - Street 2:SUITE 13
Practice Address - City:WACO
Practice Address - State:TX
Practice Address - Zip Code:76710-7814
Practice Address - Country:US
Practice Address - Phone:254-751-0266
Practice Address - Fax:254-751-1083
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-03
Last Update Date:2009-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier