MEDICARE: DIESEL PROSTHETICS AND ORTHOTICS, 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	332B00000X	Durable Medical Equipment & Medical Supplies	255	TX
2	335E00000X	Prosthetic/Orthotic Supplier	255	TX

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

General Provider Information

NPI Number	:	1992974182
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DIESEL PROSTHETICS AND ORTHOTICS, INC.

Provider Business Mailing Address
First Line	:	1411 W HOUSTON ST
Second Line	:
City	:	SHERMAN
State	:	TX
Zip	:	75092-7409
Country	:	US
Telephone Number	:	903-891-0230
Fax Number	:	903-891-8743

Provider Business Practice Location Address
First Line	:	1411 W HOUSTON ST
Second Line	:
City	:	SHERMAN
State	:	TX
Zip	:	75092-7409
Country	:	US
Telephone Number	:	903-891-0230
Fax Number	:	903-891-8743

Authorized Official
Title or Position	:	OWNER
Name	:	DOUGLAS LEE DIESEL
Credential	:	CPO, LPO
Telephone Number	:	903-891-0230

Provider Enumeration Date	:	02/21/2008
Last Update Date	:	11/02/2010

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