Provider Demographics
NPI:1912097890
Name:MEDICAL CENTER BRACE & LIMB, INC.
Entity Type:Organization
Organization Name:MEDICAL CENTER BRACE & LIMB, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:WYTHE
Authorized Official - Last Name:FAIN
Authorized Official - Suffix:II
Authorized Official - Credentials:CPO
Authorized Official - Phone:713-799-1177
Mailing Address - Street 1:17270 RED OAK DR
Mailing Address - Street 2:STE 120
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77090-2649
Mailing Address - Country:US
Mailing Address - Phone:281-893-6995
Mailing Address - Fax:281-893-6997
Practice Address - Street 1:17270 RED OAK DR
Practice Address - Street 2:STE 120
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77090-2649
Practice Address - Country:US
Practice Address - Phone:281-893-6995
Practice Address - Fax:281-893-6997
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX000062332BC3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0601280002Medicare ID - Type UnspecifiedMEDICARE ID NUMBER