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General NPI Number Information
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NPI Number | 1366504425
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Entity Type | Organization
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Legal Business Name | PROSTHETIC CENTER OF PASCO INC
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Dates
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Enumeration Date | 12/15/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 5950 HIGH STREET
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City | NEW PORT RICHEY
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State | FL
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Zip | 34652-4149
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Country | US
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Telephone | 727-846-8124
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Fax | 727-846-7109
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Provider Business Mailing Address
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Address Line | 5950 HIGH STREET
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City | NEW PORT RICHEY
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State | FL
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Zip | 34652-4149
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Country | US
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Telephone | 727-846-8124
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Fax | 727-846-7109
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Authorized Official
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Title or Position | PRESIDENT OWNER
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Name | MR. PAUL D MCCULLOUGH
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Credential | CP
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Telephone | 727-846-8124
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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 | PRO6
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License Number State | FL
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