Healthcare Provider Details

I. General information

NPI: 1558074930
Provider Name (Legal Business Name): HURD INDUSTRIES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/02/2023
Last Update Date: 01/02/2023
Certification Date: 12/31/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5067 MADRE MESA DR APT 2015
LAS VEGAS NV
89108-3592
US

IV. Provider business mailing address

5067 MADRE MESA DR APT 2015
LAS VEGAS NV
89108-3592
US

V. Phone/Fax

Practice location:
  • Phone: 903-280-5025
  • Fax:
Mailing address:
  • Phone: 903-280-5025
  • Fax:

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: CALANDRA TAHNEE HURD
Title or Position: OWNER/OPERATOR
Credential:
Phone: 903-280-5025