MEDICARE: BASIN ORTHOTIC & PROSTHETIC CENTER PLLC

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

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1780666081
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BASIN ORTHOTIC & PROSTHETIC CENTER PLLC

Provider Business Mailing Address
First Line	:	623 N SAM HOUSTON AVE
Second Line	:
City	:	ODESSA
State	:	TX
Zip	:	79761-4434
Country	:	US
Telephone Number	:	432-337-8880
Fax Number	:	432-337-8887

Provider Business Practice Location Address
First Line	:	623 N SAM HOUSTON AVE
Second Line	:
City	:	ODESSA
State	:	TX
Zip	:	79761-4434
Country	:	US
Telephone Number	:	432-337-8880
Fax Number	:	432-337-8887

Authorized Official
Title or Position	:	OWNER
Name	:	TIM C HOWELL
Credential	:	LPO,CPO,BOC-OP
Telephone Number	:	432-337-8880

Provider Enumeration Date	:	11/14/2005
Last Update Date	:	07/11/2024

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