Organization
PROSTHETIC-ORTHOTIC ASSOCIATES OF EAST TEXAS, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BRUCE P. MCCLELLAN CPO (PRESIDENT/OWNER)
(903) 592-6574
Entity
Organization
Contact information
Practice address
1028 E IDEL ST, TYLER, TX 75701-2024
(903) 592-6574
(903) 595-3862
Mailing address
1028 E IDEL ST, TYLER, TX 75701-2024
(903) 592-6574
(903) 595-3862
Taxonomy
Speciality
Code
Description
License number
State
335E00000X
Prosthetic/Orthotic Supplier
Primary
000086
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
079439801
CSHCN-PROTHETICS
TX
01
—
079440601
CSHCN-ORTHOTICS
TX
05
—
087369701
—
TX
01
—
515809
BCBS-TEXAS
—
Enumeration date
06/07/2006
Last updated
07/16/2021
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