Organization
STEVEN G MCCULLOUGH AND DAVID W HOLT ORTHOTICS & PROSTHETICS LLC
Active
Organization
STEVEN G MCCULLOUGH AND DAVID W HOLT ORTHOTICS & PROSTHETICS LLC
Active
Other names
Custom Care Orthopedic Bracing and Prosthetics
Organization subpart
No
Provider details
NPI number
Authorized official
MR. BRADFORD GARDNER (COO)
(615) 864-8783
Entity
Organization
Contact information
Practice address
1120 MEDICAL DR, TYLER, TX 75701-2109
(903) 592-5900
(903) 592-6683
Mailing address
102 WOODMONT BLVD STE 120, NASHVILLE, TN 37205-5249
(615) 864-8790
(615) 454-5352
Taxonomy
Speciality
Code
Description
License number
State
335E00000X
Prosthetic/Orthotic Supplier
Primary
101171
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
087070101
—
TX
01
—
519266
BCBS
—
Enumeration date
06/09/2006
Last updated
01/07/2020
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