Healthcare Provider Details

I. General information

NPI: 1932010691
Provider Name (Legal Business Name): ELITE PROSTHETICS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/14/2026
Last Update Date: 09/14/2026
Certification Date: 09/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1515 W CALLE SUR ST STE 101
HOBBS NM
88240-1318
US

IV. Provider business mailing address

6603 SANGER AVE
WACO TX
76710-4252
US

V. Phone/Fax

Practice location:
  • Phone: 254-752-6352
  • Fax: 254-714-2314
Mailing address:
  • Phone: 254-752-6352
  • Fax: 254-714-2314

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number State

VIII. Authorized Official

Name: DUSTIN GRICE
Title or Position: PRESIDENT
Credential:
Phone: 254-752-6352