Provider Demographics
NPI:1437776754
Name:CENTRAL TEXAS PROSTHETICS, LLC
Entity type:Organization
Organization Name:CENTRAL TEXAS PROSTHETICS, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SARA
Authorized Official - Middle Name:
Authorized Official - Last Name:ASSI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:832-726-0584
Mailing Address - Street 1:16325 WESTHEIMER RD STE 104
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77082-1233
Mailing Address - Country:US
Mailing Address - Phone:832-726-0584
Mailing Address - Fax:832-919-7085
Practice Address - Street 1:16325 WESTHEIMER RD STE 104
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77082-1233
Practice Address - Country:US
Practice Address - Phone:832-726-0584
Practice Address - Fax:832-919-7085
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-02
Last Update Date:2021-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX418729601Medicaid