Provider Demographics
NPI:1053782904
Name:LAREDO PROSTHETICS CENTER INC
Entity type:Organization
Organization Name:LAREDO PROSTHETICS CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:PIA
Authorized Official - Middle Name:
Authorized Official - Last Name:BAYLY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:281-785-4554
Mailing Address - Street 1:PO BOX 249
Mailing Address - Street 2:
Mailing Address - City:BELLAIRE
Mailing Address - State:TX
Mailing Address - Zip Code:77402
Mailing Address - Country:US
Mailing Address - Phone:956-523-0450
Mailing Address - Fax:956-523-0448
Practice Address - Street 1:10410 MEDICAL LOOP BLDG 5
Practice Address - Street 2:SUITE 5C
Practice Address - City:LAREDO
Practice Address - State:TX
Practice Address - Zip Code:78045
Practice Address - Country:US
Practice Address - Phone:956-523-0450
Practice Address - Fax:956-523-0448
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-16
Last Update Date:2015-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier