MEDICARE: SOUTHWEST PROSTHETICS WACO 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	:	1972496867
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOUTHWEST PROSTHETICS WACO LLC

Provider Business Mailing Address
First Line	:	2410 WYCON DR STE 101
Second Line	:
City	:	WACO
State	:	TX
Zip	:	76712-8990
Country	:	US
Telephone Number	:	254-224-6357
Fax Number	:	254-442-0248

Provider Business Practice Location Address
First Line	:	2410 WYCON DR STE 101
Second Line	:
City	:	WACO
State	:	TX
Zip	:	76712-8990
Country	:	US
Telephone Number	:	254-224-6357
Fax Number	:	254-442-0248

Authorized Official
Title or Position	:	OWNER
Name	:	RONALD NELSON
Credential	:
Telephone Number	:	512-931-9198

Provider Enumeration Date	:	05/30/2025
Last Update Date	:	05/30/2025

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Directions to “SOUTHWEST PROSTHETICS WACO LLC ” Practice Location

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