Organization
GULF COAST PROSTHETICS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TRACIE LEIGHANN KMIEC (OWNER)
(281) 292-2255
Entity
Organization
Contact information
Practice address
27350 BLUEBERRY HILL DR, SUITE 1, CONROE, TX 77385-8963
(281) 292-2255
(281) 292-2299
Mailing address
27350 BLUEBERRY HILL DR, SUITE 1, CONROE, TX 77385-8963
(832) 605-7466
Taxonomy
Speciality
Code
Description
License number
State
224900000X
Mastectomy Fitter
—
—
335E00000X
Prosthetic/Orthotic Supplier
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
332113502
—
TX
Enumeration date
11/16/2012
Last updated
02/14/2024
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