STEVEN G MCCULLOUGH AND DAVID W HOLT ORTHOTICS & PROSTHETICS, LLC (NPI# 1184822793) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1184822793 |
| Entity Type | Organization |
| Organization Name | STEVEN G MCCULLOUGH AND DAVID W HOLT ORTHOTICS & PROSTHETICS, LLC |
| Other Organization Name | CUSTOM CARE ORTHOPEDIC BRACING AND PROSTHETICS |
| Practice Address |
422 N Green St Longview TX 75601-6458 |
| Mailing Address |
102 Woodmont Blvd Ste 120 Nashville TN 37205-5249 |
| Practice Telephone | 9032349300 |
| Practice Fax Number | 9032348704 |
| Mailing Telephone | 6158648790 |
| Mailing Fax Number | 6154545352 |
| Enumeration Date | 2007-07-05 |
| Last Update Date | 2020-03-19 |
| Authorized Official Name | MR. BRADFORD GARDNER (COO) |
| Authorized Official Telephone | 6158648783 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 335E00000X | Prosthetic/Orthotic Supplier | 101171 | TX | Suppliers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| TX | 284080301 | 05 | |
| TX | O&P | 517688 | 01 |
| DMEPOS MEDICARE PTAN | 6922550001 | 01 | |
| TX | 284080303 | 05 |
| Other Name | Type Code |
|---|---|
| Custom Care Orthopedic Bracing and Prosthetics | Doing Business As Name - Organization |
| Street Address |
422 N GREEN ST |
| City | LONGVIEW |
| State | TX |
| Zip Code | 75601-6458 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1629379490 | Steven Glenn Mccullough | Prosthetic/Orthotic Supplier | 422 N Green St, Longview, TX 75601-6458 | 2010-11-10 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1992351076 | Stebbins Hospice LLC | Hospice Care, Community Based | 600-602 E. Whaley, Longview, TX 75601 | 2019-08-14 |
| 1720437692 | J.l. Miguez, Inc. | Hearing Aid Equipment | 822 N 4th Street, Longview, TX 75601 | 2016-06-10 |
| 1801244090 | Voyage Medical Solutions, LLC | Durable Medical Equipment & Medical Supplies | 111 W Tyler St, Longview, TX 75601 | 2016-05-27 |
| 1134504426 | Siobain Kay Rogers | Nurse Practitioner | 703 E Marshall Ave Ste 4003, Longview, TX 75601 | 2015-07-28 |
| 1669882882 | Snehal Shrivastava | Internal Medicine | 1402 N 4th St Ste 300, Longview, TX 75601 | 2014-04-28 |
| 1679824221 | Jennifer Ruth Williams | Occupational Therapist | 110 E Tyler St, Longview, TX 75601 | 2012-09-23 |
| 1548525603 | Candice Renee Ramos | Social Worker | 950 N Sixth St, Longview, TX 75601 | 2012-07-05 |
| 1497082747 | Jarett S Harkness | Pharmacist | 511 E. Marshall Avenue, Longview, TX 75601 | 2009-11-06 |
| 1407086333 | Udeme Ekpenyong | Pediatrics | 818 N. 4th St., Longview, TX 75601 | 2009-07-27 |
| 1386823359 | Assisted Living Concepts Inc | Assisted Living Facility | 2104 Alpine Road, Longview, TX 75601 | 2007-10-26 |
| Find all providers in zip 75601 | ||||
| Taxonomy Code | 335E00000X |
| Grouping | Suppliers |
| Classification | Prosthetic/Orthotic Supplier |
| An organization that provides prosthetic and orthotic care which may include, but is not limited to, patient evaluation, prosthesis or orthosis design, fabrication, fitting and modification to treat limb loss for purposes of restoring physiological function and/or cosmesis or to treat a neuromusculoskeletal disorder or acquired condition. |
| Notes: Source: American Board for Certification in Orthotics, Prosthetics, and Pedorthics, Inc. [7/1/2010: modified, 7/1/2013: modified] Additional Resources: American Board for Certification in Orthotics, Prosthetics and Pedorthics, Inc., www.abcop.org and Board of Certification/Accreditation, International, www.bocusa.org. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1326290248 | Genesis Medical Group, LLC. | Prosthetic/Orthotic Supplier | 1338 Commerce Ave Ste D, Longview, WA 98632-3743 | 2008-10-22 |
| 1447344296 | Ava Inc. | Prosthetic/Orthotic Supplier | 1113 Vandercook Way, Suite 120, Longview, WA 98632-4024 | 2006-10-03 |
| 1750323713 | Edgar De La Fuente | Prosthetic/Orthotic Supplier | 719 N. Second Street, Longview, TX 75601-5316 | 2006-06-12 |
| 1740720366 | Hanger Clinic | Prosthetic/Orthotic Supplier | 1516 Hudson St, Suite 105, Longview, WA 98632-3083 | 2017-03-01 |
| 1629379490 | Steven Glenn Mccullough | Prosthetic/Orthotic Supplier | 422 N Green St, Longview, TX 75601-6458 | 2010-11-10 |
| 1992934053 | Prosthetic-orthotic Associates of East Texas, Inc. | Prosthetic/Orthotic Supplier | 414 E Loop 281, Suite 20, Longview, TX 75605-7930 | 2009-07-10 |
| 1508048984 | East Texas Prosthetic-orthotic Care | Prosthetic/Orthotic Supplier | 812 N 4th St, Longview, TX 75601-5413 | 2007-11-28 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1124627997 | Tactical Rehabilitation Inc | Prosthetic/Orthotic Supplier | 2710 S. Clear Creek, Suite 110, Killeen, TX 76549-6685 | 2020-10-22 |
| 1962001123 | Tactical Rehabilitation Inc | Prosthetic/Orthotic Supplier | 2710 Clear Creek Rd Apt 110, Killeen, TX 76549-6685 | 2020-10-20 |
| 1871191643 | Cranial Technologies, Inc. | Prosthetic/Orthotic Supplier | 2020 W State Highway 114 Ste 360, Grapevine, TX 76051-8649 | 2020-10-14 |
| 1396351573 | Baker O & P Enterprises, Inc. | Prosthetic/Orthotic Supplier | 1104 West 34th St., Bldg. A, Austin, TX 78705-1910 | 2020-09-22 |
| 1184230815 | Lindas Signature Hair Studio Inc | Prosthetic/Orthotic Supplier | 9415 Broadway St Ste 201, Pearland, TX 77584-8094 | 2020-09-18 |
| 1538773106 | Memorial Prosthetics and Orthotics Inc | Prosthetic/Orthotic Supplier | 439 Mason Park Blvd Ste A1, Katy, TX 77450-4163 | 2020-09-01 |
| 1447861828 | Major Miracles Rx | Prosthetic/Orthotic Supplier | 1801 E 51st St Ste 362, Austin, TX 78723-3434 | 2020-08-11 |
| 1396355061 | Ameristep Prosthetics San Antonio | Prosthetic/Orthotic Supplier | 7271 Wurzbach Rd Ste 187, San Antonio, TX 78240-3800 | 2020-08-06 |
| 1043820327 | Ameristep Prosthetics Southwestern | Prosthetic/Orthotic Supplier | 5406 Harry Hines Blvd, Dallas, TX 75235-7211 | 2020-08-03 |
| 1083230502 | Amazing Wig Closet | Prosthetic/Orthotic Supplier | 409 W Front St Ste 100-306, Hutto, TX 78634-4204 | 2020-06-20 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.