PROSTHETIC-ORTHOTIC ASSOCIATES OF EAST TEXAS, INC. (NPI# 1780624148) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1780624148 |
| Entity Type | Organization |
| Organization Name | PROSTHETIC-ORTHOTIC ASSOCIATES OF EAST TEXAS, INC. |
| Practice Address |
1122 E Front St Tyler TX 75702-8414 |
| Practice Telephone | 9035926574 |
| Practice Fax Number | 9035953862 |
| Mailing Telephone | 9035926574 |
| Mailing Fax Number | 9035953862 |
| Enumeration Date | 2006-06-07 |
| Last Update Date | 2019-08-08 |
| Authorized Official Name | BRUCE P. MCCLELLAN (PRESIDENT/OWNER) |
| Authorized Official Telephone | 9035926574 |
| Authorized Official Credential | CPO |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 335E00000X | Prosthetic/Orthotic Supplier | 000086 | TX | Suppliers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| TX | CSHCN-ORTHOTICS | 079440601 | 01 |
| BCBS-TEXAS | 515809 | 01 | |
| TX | 087369701 | 05 | |
| TX | CSHCN-PROTHETICS | 079439801 | 01 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1992934053 | Prosthetic-orthotic Associates of East Texas, Inc. | Prosthetic/Orthotic Supplier | 414 E Loop 281, Suite 20, Longview, TX 75605-7930 | 2009-07-10 |
| Street Address |
1122 E FRONT ST |
| City | TYLER |
| State | TX |
| Zip Code | 75702-8414 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1073134177 | Matthew Bruce Mcclellan | Orthotist | 1122 E Front St, Tyler, TX 75702-8414 | 2020-04-29 |
| 1104976182 | Bruce Patrick Mcclellan | Orthotist | 1122 E Front St, Tyler, TX 75702-8414 | 2007-01-11 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1679116610 | Tiffiney Mcmakin | Nurse Practitioner | 810 E Houston St # 100, Tyler, TX 75702 | 2019-10-22 |
| 1659852507 | Krystal Gayle Lilley | Licensed Vocational Nurse | 100 E Ferguson St Ste 60a, Tyler, TX 75702 | 2018-08-28 |
| 1679029383 | Cynthia Lynn Kalawe | Physical Therapist | 100 E Ferguson, Suite 1204, Tyler, TX 75702 | 2016-09-01 |
| 1649623646 | Susan E Oxford | Social Worker | 13495 Frankston Highway, Tyler, TX 75702 | 2016-07-14 |
| 1053769281 | All Kidz Kan | Home Health | 2902 E Front St, Tyler, TX 75702 | 2016-05-27 |
| 1821415639 | Heather Mullins | Physical Therapy Assistant | 100 E. Ferguson Ste.1204, Tyler, TX 75702 | 2014-03-19 |
| 1346671336 | Dennis Keith Johnson | Dentist | 3081 Hwy. 31 East, Tyler, TX 75702 | 2013-12-02 |
| 1275882201 | Bobby Gibson | Counselor | 401 East Front Street, Ste 233, Tyler, TX 75702 | 2012-09-06 |
| 1144596792 | Tina Marie Borke | Clinical Neuropsychologist | 719 West Front St., Tyler, TX 75702 | 2012-03-28 |
| 1457629529 | James Whaley Rapp | Specialist/Technologist | 430 South Beckham Avenue, Trinity Mother Frances Sports Medicine, Tyler, TX 75702 | 2011-12-05 |
| Find all providers in zip 75702 | ||||
| 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 |
|---|---|---|---|---|
| 1073141354 | Positive Hair Restoration | Prosthetic/Orthotic Supplier | 100 Independence Pl Ste 309, Tyler, TX 75703-1328 | 2020-03-31 |
| 1467763532 | Frazier Optical Inc. | Prosthetic/Orthotic Supplier | 2531 E 5th St, Tyler, TX 75701-3544 | 2010-06-23 |
| 1679748131 | Neal's Prosthetics, Inc. | Prosthetic/Orthotic Supplier | 701 Turtle Creek Dr, Tyler, TX 75701-1834 | 2008-04-25 |
| 1699967067 | Hedgecock Artificial Limb Co., Inc | Prosthetic/Orthotic Supplier | 1917 S Beckham Ave, Tyler, TX 75701-4453 | 2007-08-09 |
| 1275676942 | Kimberly B. Kennedy, Inc. | Prosthetic/Orthotic Supplier | 1733 Troup Hwy, Tyler, TX 75701-5869 | 2007-02-14 |
| 1215978424 | Steven G Mccullough and David W Holt Orthotics & Prosthetics LLC | Prosthetic/Orthotic Supplier | 1120 Medical Dr, Tyler, TX 75701-2109 | 2006-06-09 |
| 1447250055 | Laurie Dowell | Prosthetic/Orthotic Supplier | 704 S Bois D Arc Ave, Tyler, TX 75701-1503 | 2005-07-26 |
| 1962013011 | Baker O & P Enterprises, Inc. | Prosthetic/Orthotic Supplier | 1819 Troup Hwy, Tyler, TX 75701-5870 | 2020-08-12 |
| 1932363751 | Steven G Mccullough | Prosthetic/Orthotic Supplier | 1120 Medical Dr, Tyler, TX 75701-2109 | 2008-07-10 |
| 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.