Provider Demographics
NPI:1932295987
Name:MEDICAL ART PROSTHETICS, LLC
Entity Type:Organization
Organization Name:MEDICAL ART PROSTHETICS, LLC
Other - Org Name:GREG GION
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:GREG
Authorized Official - Middle Name:G
Authorized Official - Last Name:GION
Authorized Official - Suffix:
Authorized Official - Credentials:MMS, CCA
Authorized Official - Phone:214-363-2055
Mailing Address - Street 1:10501 N CENTRAL EXPY
Mailing Address - Street 2:SUITE 314
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75231-2220
Mailing Address - Country:US
Mailing Address - Phone:214-363-2055
Mailing Address - Fax:214-363-2092
Practice Address - Street 1:10501 N CENTRAL EXPY
Practice Address - Street 2:SUITE 314
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75231-2220
Practice Address - Country:US
Practice Address - Phone:214-363-2055
Practice Address - Fax:214-363-2092
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-05
Last Update Date:2010-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX01015181229N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes229N00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersAnaplastologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI41753500Medicaid
KS100394180 AMedicaid
TX509319OtherBCBS
TX086930701Medicaid
WI41753500Medicaid