MEDICARE: PROCARE ORTHOTICS & PROSTHETICS INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist	56	TX
2	332B00000X	Durable Medical Equipment & Medical Supplies	101038	TX
3	335E00000X	Prosthetic/Orthotic Supplier	101038	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	530861	OTHER	TX	BLUECROSS BLUESHIELD ID#

General Provider Information

NPI Number	:	1114926888
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PROCARE ORTHOTICS & PROSTHETICS INC

Provider Business Mailing Address
First Line	:	1311 PRINCE CREEK CT
Second Line	:
City	:	KATY
State	:	TX
Zip	:	77450-4924
Country	:	US
Telephone Number	:	713-799-1000
Fax Number	:	713-799-1260

Provider Business Practice Location Address
First Line	:	11261 RICHMOND AVE STE 101
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77082-2676
Country	:	US
Telephone Number	:	713-799-1000
Fax Number	:	713-799-1260

Authorized Official
Title or Position	:	MANAGER
Name	:	MR. BILL E HEARN
Credential	:
Telephone Number	:	713-799-1000

Provider Enumeration Date	:	07/15/2005
Last Update Date	:	05/17/2021

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Directions to “PROCARE ORTHOTICS & PROSTHETICS INC ” Practice Location

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