Provider Demographics
NPI:1316138241
Name:J & C ORTHOTICS AND PROSTHETICS
Entity type:Organization
Organization Name:J & C ORTHOTICS AND PROSTHETICS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ORTHOTIST/OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:CHERYL
Authorized Official - Middle Name:GAYE
Authorized Official - Last Name:CHANCE
Authorized Official - Suffix:
Authorized Official - Credentials:LOCO
Authorized Official - Phone:409-833-8600
Mailing Address - Street 1:3195 CALDER ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:BEAUMONT
Mailing Address - State:TX
Mailing Address - Zip Code:77702-1410
Mailing Address - Country:US
Mailing Address - Phone:409-833-8600
Mailing Address - Fax:409-833-8605
Practice Address - Street 1:3195 CALDER ST
Practice Address - Street 2:SUITE 200
Practice Address - City:BEAUMONT
Practice Address - State:TX
Practice Address - Zip Code:77702-1410
Practice Address - Country:US
Practice Address - Phone:409-833-8600
Practice Address - Fax:409-833-8605
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-06
Last Update Date:2023-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX101129332BC3200X, 332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
2460841OtherUNITED HEALTHCARE
TX531812OtherBLU CROSS BLUE SHIELD
10018181OtherAMERIGROUP
TX164392601Medicaid
21919OtherUTMB CHIPS
TX4867530001OtherMEDICARE DMEPOS
TX531812OtherBLU CROSS BLUE SHIELD
TX=========OtherAETNA
TX164392601Medicaid
=========OtherHUMANA
10018181OtherAMERIGROUP