Organization
PEDIATRIC ORTHOTIC AND PROSTHETIC SERVICES-SOUTHEAST, LLC
Active
Parent organization
PEDIATRIC ORTHOTIC AND PROSTHETIC SERVICES-SOUTHEAST, LLC
Organization subpart
Yes
Provider details
NPI number
Legal business name
PEDIATRIC ORTHOTIC AND PROSTHETIC SERVICES-SOUTHEAST, LLC
Authorized official
MR. JOSEPH ANTHONY GOMEZ BOCO (DIRECTOR OF O&P)
(318) 226-4279
Entity
Organization
Contact information
Practice address
3100 SAMFORD AVE, SHREVEPORT, LA 71103-4239
(318) 226-3310
(318) 226-4294
Mailing address
PO BOX 947109, ATLANTA, GA 30394-7109
(318) 226-3310
(813) 226-4294
Taxonomy
Speciality
Code
Description
License number
State
335E00000X
Prosthetic/Orthotic Supplier
Primary
—
—
Other
Enumeration date
11/12/2014
Last updated
04/23/2025
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