Basic Information
| Provider Information | |||||||||
| NPI: | 1750308482 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | VALLEY ORTHOPEDIC & PROSTHETICS INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 331580 | ||||||||
| Address2: | |||||||||
| City: | CORPUS CHRISTI | ||||||||
| State: | TX | ||||||||
| PostalCode: | 78463 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3618887752 | ||||||||
| FaxNumber: | 3618887424 | ||||||||
| Practice Location | |||||||||
| Address1: | 900 E HWY 77 | ||||||||
| Address2: | |||||||||
| City: | SAN BENITO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 78586 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9563991129 | ||||||||
| FaxNumber: | 9563991360 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/17/2006 | ||||||||
| LastUpdateDate: | 03/03/2011 | ||||||||
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| AuthorizedOfficialLastName: | SEARS | ||||||||
| AuthorizedOfficialFirstName: | ANGELA | ||||||||
| AuthorizedOfficialMiddleName: | M | ||||||||
| AuthorizedOfficialTitleorPosition: | CORP OFFICER SECRETARY TREASURER | ||||||||
| AuthorizedOfficialTelephone: | 3618887752 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 335E00000X | 000102 | TX | Y | Suppliers | Prosthetic/Orthotic Supplier |
ID Information
| ID | Type | State | Issuer | Description | 01100473701 | 05 | TX | MEDICAID |