MEDICARE: HOPE ORTHOTICS, LLC

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	222Z00000X	Orthotist
2	224P00000X	Prosthetist
3	332B00000X	Durable Medical Equipment & Medical Supplies	1000733	TX
4	335E00000X	Prosthetic/Orthotic Supplier	101407	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0108144-03	OTHER	TX	CWSHCN TEXAS
2	30959	OTHER	TN	AMERIGROUP
3	=========	OTHER	TX	DARS
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
6	0108144-03	OTHER	TX	CWSHLN-TX
7	30959	OTHER	TX	AMERIGROUP
8	530321	OTHER	TX	BLUE CROSS BLUE SHIELD

General Provider Information

NPI Number	:	1487652749
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HOPE ORTHOTICS, LLC

Provider Business Mailing Address
First Line	:	P O BOX 650846
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75265-0846
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	230 SPRING HILL DR STE 335
Second Line	:
City	:	SPRING
State	:	TX
Zip	:	77386-2388
Country	:	US
Telephone Number	:	281-296-8999
Fax Number	:	281-296-8989

Authorized Official
Title or Position	:	REG COMPLIANCE SPECIALIST IV
Name	:	GRACE ANGELINE
Credential	:
Telephone Number	:	714-961-2102

Provider Enumeration Date	:	07/12/2005
Last Update Date	:	12/02/2022

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HOPE ORTHOTICS, LLC - ATTN: MAYA GOUGEON, LO , 230 SPRING HILL DRIVE, SUITE 335
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77386-2388

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Directions to “HOPE ORTHOTICS, LLC ” Practice Location

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