Provider Demographics
NPI:1699967067
Name:HEDGECOCK ARTIFICIAL LIMB CO., INC
Entity type:Organization
Organization Name:HEDGECOCK ARTIFICIAL LIMB CO., INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANN
Authorized Official - Middle Name:
Authorized Official - Last Name:CICERO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-744-3278
Mailing Address - Street 1:2909 CANTON ST STE C
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75226-3508
Mailing Address - Country:US
Mailing Address - Phone:214-744-3278
Mailing Address - Fax:214-744-3280
Practice Address - Street 1:1917 S BECKHAM AVE
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75701-4453
Practice Address - Country:US
Practice Address - Phone:903-531-2228
Practice Address - Fax:903-531-2229
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-09
Last Update Date:2007-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX000050335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0319590001Medicare PIN