Provider Demographics
NPI:1306150800
Name:AA PROSTHETIC SERVICES INC
Entity type:Organization
Organization Name:AA PROSTHETIC SERVICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:GEORGE
Authorized Official - Last Name:CRAIG
Authorized Official - Suffix:
Authorized Official - Credentials:CPO/LPO
Authorized Official - Phone:325-200-4467
Mailing Address - Street 1:2408 COGGIN AVE
Mailing Address - Street 2:
Mailing Address - City:BROWNWOOD
Mailing Address - State:TX
Mailing Address - Zip Code:76801-5336
Mailing Address - Country:US
Mailing Address - Phone:325-200-4467
Mailing Address - Fax:866-234-4150
Practice Address - Street 1:2408 COGGIN AVE
Practice Address - Street 2:
Practice Address - City:BROWNWOOD
Practice Address - State:TX
Practice Address - Zip Code:76801-5336
Practice Address - Country:US
Practice Address - Phone:325-200-4467
Practice Address - Fax:866-234-4150
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-27
Last Update Date:2010-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX101335332B00000X, 335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX6419510001Medicare NSC