MEDICARE: ADVANCED PROSTHETIC RESEARCH WACO, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	335E00000X	Prosthetic/Orthotic Supplier	1014897	TX

General Provider Information

NPI Number	:	1134526296
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ADVANCED PROSTHETIC RESEARCH WACO, INC.

Provider Business Mailing Address
First Line	:	PO BOX 251729
Second Line	:
City	:	PLANO
State	:	TX
Zip	:	75025-1729
Country	:	US
Telephone Number	:	469-219-7878
Fax Number	:	855-710-8016

Provider Business Practice Location Address
First Line	:	2410 WYCON DR
Second Line	:	STE 101
City	:	WACO
State	:	TX
Zip	:	76712-8957
Country	:	US
Telephone Number	:	254-235-1477
Fax Number	:	855-710-8016

Authorized Official
Title or Position	:	OWNER/OPERATOR
Name	:	MRS. JAN-MORGAN GAINER
Credential	:	LP
Telephone Number	:	254-235-1477

Provider Enumeration Date	:	12/04/2014
Last Update Date	:	12/04/2014

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