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General NPI Number Information
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NPI Number | 1457348823
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Entity Type | Organization
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Legal Business Name | PROSTHETIC CENTER OF EXCELLENCE, A NEVADA CORPORATION
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Dates
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Enumeration Date | 09/30/2005
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Last Update Date | 11/14/2023
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Provider Practice Location Address
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Address Line | 2047 W CHARLESTON BLVD STE 100
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City | LAS VEGAS
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State | NV
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Zip | 89102-2251
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Country | US
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Telephone | 702-384-1410
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Fax | 702-384-0479
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Provider Business Mailing Address
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Address Line | PO BOX 650846
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City | DALLAS
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State | TX
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Zip | 75265-0846
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PROVIDER CONTRACT ANALYST III
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Name | GRACE ANGELINE
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Credential |
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Telephone | 714-961-2102
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number |
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License Number State |
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Taxonomy #2
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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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