Provider Demographics
NPI:1720211949
Name:LIFECARE PROSTHETICS AND ORTHOTICS PLLC
Entity type:Organization
Organization Name:LIFECARE PROSTHETICS AND ORTHOTICS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DEANNA
Authorized Official - Middle Name:P
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:LPO, CO
Authorized Official - Phone:972-298-0018
Mailing Address - Street 1:212 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:DUNCANVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75116-3649
Mailing Address - Country:US
Mailing Address - Phone:972-298-0018
Mailing Address - Fax:972-298-0019
Practice Address - Street 1:212 N MAIN ST
Practice Address - Street 2:
Practice Address - City:DUNCANVILLE
Practice Address - State:TX
Practice Address - Zip Code:75116-3649
Practice Address - Country:US
Practice Address - Phone:972-298-0018
Practice Address - Fax:972-298-0019
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-03
Last Update Date:2012-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX101313335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX6352940001Medicare NSC