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Organization

STEVEN G MCCULLOUGH

Active
Other names
Custom Care Orthopedic Bracing LLC
Organization subpart
No

Provider details

NPI number
Authorized official
MR. STEVEN GLENN MCCULLOUGH CERTIFIED ORTHOTIST (OWNER)
(903) 592-5900
Entity
Organization

Contact information

Practice address
1120 MEDICAL DR, TYLER, TX 75701-2109
(903) 592-5900
(903) 592-6683
Mailing address
1110 MEDICAL DR, TYLER, TX 75701-2109
(903) 592-5900
(903) 592-6683

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
Enumeration date
07/10/2008
Last updated
07/10/2008
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