MEDICARE: PROSTHETIC SOLUTION CENTERS OF AMERICA, 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	335E00000X	Prosthetic/Orthotic Supplier

General Provider Information

NPI Number	:	1508296021
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PROSTHETIC SOLUTION CENTERS OF AMERICA, LLC

Provider Business Mailing Address
First Line	:	PO BOX 90939
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77290-0939
Country	:	US
Telephone Number	:	713-790-1185
Fax Number	:	713-790-1197

Provider Business Practice Location Address
First Line	:	1417 S LOOP W
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77054-3815
Country	:	US
Telephone Number	:	713-790-1185
Fax Number	:	713-790-1197

Authorized Official
Title or Position	:	COO
Name	:	MR. DALE STUART LEE SHEEN
Credential	:	L.P.O
Telephone Number	:	281-580-8228

Provider Enumeration Date	:	11/19/2013
Last Update Date	:	01/28/2019

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