Organization
EAST TEXAS PROSTHETIC-ORTHOTIC CARE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. ROBERT M. WRIGHT III C.P.O. (PRESIDENT/CEO)
(903) 236-4488
Entity
Organization
Contact information
Practice address
812 N 4TH ST, LONGVIEW, TX 75601-5413
(903) 236-4488
(903) 236-4607
Mailing address
812 N 4TH ST, LONGVIEW, TX 75601-5413
(903) 236-4488
(903) 236-4607
Taxonomy
Speciality
Code
Description
License number
State
335E00000X
Prosthetic/Orthotic Supplier
Primary
000020
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
010236001
—
TX
01
—
519698
BLUE CROSS BLUE SHIELD
TX
Enumeration date
11/28/2007
Last updated
06/25/2013
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