MEDICARE: PROSTHETICARE FORT WORTH LP

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	10128	TX

General Provider Information

NPI Number	:	1295959492
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PROSTHETICARE FORT WORTH LP

Provider Business Mailing Address
First Line	:	7241 HAWKINS VIEW DR
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76132-3921
Country	:	US
Telephone Number	:	817-336-8293
Fax Number	:	817-336-9017

Provider Business Practice Location Address
First Line	:	7241 HAWKINS VIEW DR
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76132-3921
Country	:	US
Telephone Number	:	817-336-8293
Fax Number	:	817-336-9017

Authorized Official
Title or Position	:	CEO
Name	:	IVAN SABEL
Credential	:
Telephone Number	:	817-336-8293

Provider Enumeration Date	:	04/12/2007
Last Update Date	:	05/12/2026

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