Steven G McCullough and David W Holt Orthotics & Prosthetics, LLC

Primary specialty

Prosthetic/Orthotic SupplierTaxonomy code 335E00000X

License

101171 Issued in TX

Legal business name

STEVEN G MCCULLOUGH AND DAVID W HOLT ORTHOTICS & PROSTHETICS, LLC

Doing business as

Custom Care Orthopedic Bracing and Prosthetics

Practice address

422 N Green St
Longview, TX 75601-6458

Phone

(903) 234-9300

Fax

(903) 234-8704

NPI assigned

Jul 5, 2007

Last updated

Mar 19, 2020By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Bradford Gardner

Title

Coo

Phone

(615) 864-8783

Specialties & licenses 1

Addresses

Other identifiers 4

Other names 1

• Custom Care Orthopedic Bracing and Prosthetics Doing business as

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Steven Glenn McCullough, C.O.L.O.

  • Prosthetic/Orthotic Supplier
  • Longview, TX
  • NPI 1629379490
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1183593600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1584576000000",
    "number": "1184822793",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "102 WOODMONT BLVD STE 120",
            "city": "NASHVILLE",
            "state": "TN",
            "postal_code": "372055249",
            "telephone_number": "615-864-8790",
            "fax_number": "615-454-5352"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "422 N GREEN ST",
            "city": "LONGVIEW",
            "state": "TX",
            "postal_code": "756016458",
            "telephone_number": "903-234-9300",
            "fax_number": "903-234-8704"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "STEVEN G MCCULLOUGH AND DAVID W HOLT ORTHOTICS & PROSTHETICS, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-07-05",
        "last_updated": "2020-03-19",
        "certification_date": "2020-03-19",
        "status": "A",
        "authorized_official_last_name": "GARDNER",
        "authorized_official_first_name": "BRADFORD",
        "authorized_official_title_or_position": "COO",
        "authorized_official_telephone_number": "615-864-8783",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "335E00000X",
            "taxonomy_group": "",
            "desc": "Prosthetic/Orthotic Supplier",
            "state": "TX",
            "license": "101171",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "284080303",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "O&P",
            "identifier": "517688",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DMEPOS MEDICARE PTAN",
            "identifier": "6922550001",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "284080301",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Custom Care Orthopedic Bracing and Prosthetics",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Custom Care Orthopedic Bracing and Prosthetics",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Glenda Nell Stegall, RN
• Stephen Somerville MD PA
• Celeste Stephens, PT, DPT
• Jennifer Stephens
• Thaddeus Stephenson Jr., RKT
• Dixie Stevenson, APN
• Justin Steward, ACNP
• Charles Clayton Stewart
• Rachel Emily Still
• A'Lyecia Ruth Stills, LMSW

• Prosthetic/Orthotic Supplier in Longview, TX
• Providers in Longview, TX by specialty
• Prosthetic/Orthotic Supplier in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 19, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.