Healthcare Provider Details

I. General information

NPI: 1235149824
Provider Name (Legal Business Name): C C PROSTHETICS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/08/2006
Last Update Date: 10/18/2024
Certification Date: 10/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1326 SANTA FE ST
CORPUS CHRISTI TX
78404-2214
US

IV. Provider business mailing address

PO BOX 650846
DALLAS TX
75265-0846
US

V. Phone/Fax

Practice location:
  • Phone: 361-888-7752
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number000016
License Number StateTX

VIII. Authorized Official

Name: GRACE ANGELINE
Title or Position: PROVIDER CONTRACT ANALYST III
Credential:
Phone: 714-961-2102