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General NPI Number Information
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NPI Number | 1083592364
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Entity Type | Organization
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Legal Business Name | PROSTHETIC-ORTHOTIC ASSOCIATES OF EAST TEXAS, INC.
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Dates
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Enumeration Date | 08/25/2025
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Last Update Date | 02/10/2026
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Provider Practice Location Address
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Address Line | 713 N 4TH ST STE 2
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City | LONGVIEW
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State | TX
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Zip | 75601-5412
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Country | US
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Telephone | 430-240-8767
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Fax | 430-240-4475
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Provider Business Mailing Address
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Address Line | 1028 E IDEL ST
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City | TYLER
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State | TX
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Zip | 75701-2024
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Country | US
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Telephone | 903-592-6574
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Fax | 903-595-3862
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Authorized Official
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Title or Position | PRESIDENT
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Name | BRUCE P MCCLELLAN
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Credential | CPO
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Telephone | 903-592-6574
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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 |
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License Number State |
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