=====================================================
General NPI Number Information
=====================================================
NPI Number | 1801850474
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CERTIFIED PROSTHETICS & ORTHOTICS, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/12/2006
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 304 GEMINI CT
-----------------------------------------------------
City | VICTORIA
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77901-2679
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 361-575-2877
-----------------------------------------------------
Fax | 361-575-5111
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 4646
-----------------------------------------------------
City | VICTORIA
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77903-4646
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 361-575-2877
-----------------------------------------------------
Fax | 361-575-5111
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | MR. RAY D. SMITH
-----------------------------------------------------
Credential | CPO, LPO
-----------------------------------------------------
Telephone | 361-575-2877
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 332B00000X
-----------------------------------------------------
Taxonomy Name | Durable Medical Equipment & Medical Supplies
-----------------------------------------------------
License Number | 14
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------