Provider Demographics
NPI:1194156372
Name:PROSTHETIC SOLUTION CENTERS OF AMERICA, LLC
Entity type:Organization
Organization Name:PROSTHETIC SOLUTION CENTERS OF AMERICA, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:MR
Authorized Official - First Name:DALE
Authorized Official - Middle Name:STUART LEE
Authorized Official - Last Name:SHEEN
Authorized Official - Suffix:
Authorized Official - Credentials:LPO
Authorized Official - Phone:281-580-8228
Mailing Address - Street 1:PO BOX 90939
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77290-0939
Mailing Address - Country:US
Mailing Address - Phone:409-839-8888
Mailing Address - Fax:409-839-8889
Practice Address - Street 1:3185 CALDER ST
Practice Address - Street 2:
Practice Address - City:BEAUMONT
Practice Address - State:TX
Practice Address - Zip Code:77702-1410
Practice Address - Country:US
Practice Address - Phone:409-839-8888
Practice Address - Fax:409-839-8889
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PROSTHETIC SOLUTION CENTERS OF AMERICA, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-12-12
Last Update Date:2019-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier