MEDICARE: STRANDZ MEDICAL PROSTHETICS LLC

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	332BC3200X	Customized Equipment (DME)

General Provider Information

NPI Number	:	1275017543
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	STRANDZ MEDICAL PROSTHETICS LLC

Provider Business Mailing Address
First Line	:	PO BOX 2107
Second Line	:
City	:	NEDERLAND
State	:	TX
Zip	:	77627-8107
Country	:	US
Telephone Number	:	832-968-2899
Fax Number	:

Provider Business Practice Location Address
First Line	:	2254 SALISBURY DR
Second Line	:
City	:	PORT ARTHUR
State	:	TX
Zip	:	77640-1741
Country	:	US
Telephone Number	:	409-736-1385
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	SHELLY MCDANIEL
Credential	:
Telephone Number	:	409-365-8644

Provider Enumeration Date	:	09/21/2018
Last Update Date	:	09/21/2018

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