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General NPI Number Information
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NPI Number | 1033462767
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Entity Type | Organization
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Legal Business Name | MEDICAL CITY BRACE & LIMB, PLLC
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Dates
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Enumeration Date | 10/18/2012
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Last Update Date | 05/24/2013
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Provider Practice Location Address
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Address Line | 8239 ALMEDA RD
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City | HOUSTON
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State | TX
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Zip | 77054-4101
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Country | US
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Telephone | 713-748-0250
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Fax | 713-748-0840
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Provider Business Mailing Address
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Address Line | 8239 ALMEDA RD
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City | HOUSTON
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State | TX
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Zip | 77054-4101
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Country | US
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Telephone | 713-748-0250
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Fax | 713-748-0840
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Authorized Official
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Title or Position | CERTIFIED PROSTHETIST
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Name | BRYAN SPARKS
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Credential | BS, CP, LP
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Telephone | 713-748-0250
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 335E00000X
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Taxonomy Name | Prosthetic/Orthotic Supplier
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License Number | 101422
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License Number State | TX
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