Lone Star Prosthetics, LLC

Primary specialty

Prosthetic/Orthotic SupplierTaxonomy code 335E00000X

License

101595 Issued in TX

Legal business name

LONE STAR PROSTHETICS, LLC

Practice address

2201 Brookhollow Plaza Dr Ste 350
Arlington, TX 76006-7443

Phone

(817) 649-8144

Fax

(844) 859-1443

NPI assigned

Feb 23, 2018

Organization subpart

No

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

Authorized official

Name

Bryan Wesley Pettit, LICENSED PROSTHETIST

Title

Owner/Prosthetic Practitioner

Phone

(817) 649-8144

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in TX

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

Medicare medical equipment & supply locations

Locations

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

{
    "created_epoch": "1519344000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1519344000000",
    "number": "1467953653",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2201 BROOKHOLLOW PLAZA DR STE 350",
            "city": "ARLINGTON",
            "state": "TX",
            "postal_code": "760067443",
            "telephone_number": "817-649-8144",
            "fax_number": "844-859-1443"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2201 BROOKHOLLOW PLAZA DR STE 350",
            "city": "ARLINGTON",
            "state": "TX",
            "postal_code": "760067443",
            "telephone_number": "817-649-8144",
            "fax_number": "844-859-1443"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LONE STAR PROSTHETICS, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-02-23",
        "last_updated": "2018-02-23",
        "status": "A",
        "authorized_official_last_name": "PETTIT",
        "authorized_official_first_name": "BRYAN",
        "authorized_official_middle_name": "WESLEY",
        "authorized_official_title_or_position": "OWNER/PROSTHETIC PRACTITIONER",
        "authorized_official_telephone_number": "817-649-8144",
        "authorized_official_credential": "LICENSED PROSTHETIST"
    },
    "taxonomies": [
        {
            "code": "335E00000X",
            "taxonomy_group": "",
            "desc": "Prosthetic/Orthotic Supplier",
            "state": "TX",
            "license": "101595",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Lone Star Tox Screen
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• Cameron Wade Long, LPC
• Dejanae Long

• Prosthetic/Orthotic Supplier in Arlington, TX
• Providers in Arlington, 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 Feb 23, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.