Provider Demographics
NPI:1932149689
Name:SPECIALTY PROSTHETICS & ORTHOTICS OF TEXAS LLC
Entity Type:Organization
Organization Name:SPECIALTY PROSTHETICS & ORTHOTICS OF TEXAS LLC
Other - Org Name:SPECIALTY PROSTHETICS & ORTHOTICS OF TEXAS LLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:
Authorized Official - Last Name:KHU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:210-932-3000
Mailing Address - Street 1:98 BRIGGS ST
Mailing Address - Street 2:SUITE 950
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78224-1286
Mailing Address - Country:US
Mailing Address - Phone:210-932-3000
Mailing Address - Fax:210-932-3040
Practice Address - Street 1:98 BRIGGS ST
Practice Address - Street 2:SUITE 950
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78224-1286
Practice Address - Country:US
Practice Address - Phone:210-932-3000
Practice Address - Fax:210-932-3040
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-08
Last Update Date:2011-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX0065744332B00000X, 335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX156537602Medicaid
TX156537601Medicaid
TX6606320001Medicare NSC