MEDICARE: PRESCOTT LIMB & BRACES 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	101008	TX

General Provider Information

NPI Number	:	1952463424
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PRESCOTT LIMB & BRACES INC

Provider Business Mailing Address
First Line	:	6715 SAN PEDRO AVE
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78216-7218
Country	:	US
Telephone Number	:	210-224-0726
Fax Number	:	210-341-3164

Provider Business Practice Location Address
First Line	:	3906 N LAMAR BLVD
Second Line	:	STE 100
City	:	AUSTIN
State	:	TX
Zip	:	78756-4000
Country	:	US
Telephone Number	:	512-452-6479
Fax Number	:	512-452-3222

Authorized Official
Title or Position	:	OWNER
Name	:	MR. GARY WAYNE PRESCOTT
Credential	:	C.O.
Telephone Number	:	512-452-6479

Provider Enumeration Date	:	12/14/2006
Last Update Date	:	11/13/2007

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