Provider Demographics
NPI:1194051383
Name:B&L PROSTHETICS
Entity type:Organization
Organization Name:B&L PROSTHETICS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:BROOKS
Authorized Official - Middle Name:RYAN
Authorized Official - Last Name:RANEY
Authorized Official - Suffix:
Authorized Official - Credentials:CP
Authorized Official - Phone:936-634-0013
Mailing Address - Street 1:704 GASLIGHT BLVD
Mailing Address - Street 2:
Mailing Address - City:LUFKIN
Mailing Address - State:TX
Mailing Address - Zip Code:75904-3153
Mailing Address - Country:US
Mailing Address - Phone:936-634-0013
Mailing Address - Fax:936-634-0015
Practice Address - Street 1:704 GASLIGHT BLVD
Practice Address - Street 2:
Practice Address - City:LUFKIN
Practice Address - State:TX
Practice Address - Zip Code:75904-3153
Practice Address - Country:US
Practice Address - Phone:936-634-0013
Practice Address - Fax:936-634-0015
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-23
Last Update Date:2019-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1418335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
6408660001Medicare NSC