Provider Demographics
NPI:1134526296
Name:ADVANCED PROSTHETIC RESEARCH WACO, INC.
Entity type:Organization
Organization Name:ADVANCED PROSTHETIC RESEARCH WACO, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPERATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:JAN-MORGAN
Authorized Official - Middle Name:
Authorized Official - Last Name:GAINER
Authorized Official - Suffix:
Authorized Official - Credentials:LP
Authorized Official - Phone:254-235-1477
Mailing Address - Street 1:PO BOX 251729
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75025-1729
Mailing Address - Country:US
Mailing Address - Phone:469-219-7878
Mailing Address - Fax:855-710-8016
Practice Address - Street 1:2410 WYCON DR
Practice Address - Street 2:STE 101
Practice Address - City:WACO
Practice Address - State:TX
Practice Address - Zip Code:76712-8957
Practice Address - Country:US
Practice Address - Phone:254-235-1477
Practice Address - Fax:855-710-8016
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-04
Last Update Date:2014-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1014897335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier