Provider Demographics
NPI:1215262373
Name:RELIANT PROSTHETICS
Entity type:Organization
Organization Name:RELIANT PROSTHETICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROSTHETIST/ORTHOTIST
Authorized Official - Prefix:MR
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:THOMAS
Authorized Official - Last Name:LOPOSER
Authorized Official - Suffix:
Authorized Official - Credentials:LPO
Authorized Official - Phone:972-470-0300
Mailing Address - Street 1:5481 BLAIR RD STE 100
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75231-4101
Mailing Address - Country:US
Mailing Address - Phone:972-470-0300
Mailing Address - Fax:972-470-0301
Practice Address - Street 1:5481 BLAIR RD STE 100
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75231-4101
Practice Address - Country:US
Practice Address - Phone:972-470-0300
Practice Address - Fax:972-470-0301
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-07
Last Update Date:2019-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX213070001Medicaid
TX213070001Medicaid
TX213070001Medicaid