Healthcare Provider Details

I. General information

NPI: 1427059203
Provider Name (Legal Business Name): ROUND ROCK ORTHOTICS & PROSTHETICS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/03/2005
Last Update Date: 01/03/2023
Certification Date: 01/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

555 ROUND ROCK WEST DR BLDG D
ROUND ROCK TX
78681-5052
US

IV. Provider business mailing address

PO BOX 650846
DALLAS TX
75265-0846
US

V. Phone/Fax

Practice location:
  • Phone: 512-341-3700
  • Fax: 512-341-3738
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 Number101122
License Number StateTX

VIII. Authorized Official

Name: GRACE ANGELINE
Title or Position: REG COMPLIANCE SPECIALIST IV
Credential:
Phone: 714-961-2102