1275675035 NPI number — CALDWELL PROSTHETICS AND ORTHOTICS, LLC

Table of content: (NPI 1275675035)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1275675035 NPI number — CALDWELL PROSTHETICS AND ORTHOTICS, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CALDWELL PROSTHETICS AND ORTHOTICS, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1275675035
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/06/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
330 INDUSTRIAL BLVD
Provider Second Line Business Mailing Address:
SUITE 110
Provider Business Mailing Address City Name:
MCKINNEY
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75069-7305
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
972-548-7707
Provider Business Mailing Address Fax Number:
972-548-7739

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
330 INDUSTRIAL BLVD
Provider Second Line Business Practice Location Address:
110
Provider Business Practice Location Address City Name:
MCKINNEY
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75069-7305
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
972-548-7707
Provider Business Practice Location Address Fax Number:
972-548-7739
Provider Enumeration Date:
02/12/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
CALDWELL
Authorized Official First Name:
DAVID
Authorized Official Middle Name:
GLENN
Authorized Official Title or Position:
MANAGING MEMBER
Authorized Official Telephone Number:
972-375-3892

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 332BC3200X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 335E00000X , with the licence number: 1224 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 335E00000X , with the licence number: 101229 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)