Gulf Coast Prosthetics

Primary specialty

Prosthetic/Orthotic SupplierTaxonomy code 335E00000X

Legal business name

GULF COAST PROSTHETICS

Practice address

27350 Blueberry Hill Dr
Suite 1
Conroe, TX 77385-8963

Phone

(281) 292-2255

Fax

(281) 292-2299

NPI assigned

Nov 16, 2012

Organization subpart

No

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

Authorized official

Name

Tracie Leighann Kmiec

Title

Owner

Phone

(281) 292-2255

Specialties & licenses 2

Addresses

Other identifiers 1

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": "1353024000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1707868800000",
    "number": "1801130620",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "27350 BLUEBERRY HILL DR",
            "address_2": "SUITE 1",
            "city": "CONROE",
            "state": "TX",
            "postal_code": "773858963",
            "telephone_number": "832-605-7466"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "27350 BLUEBERRY HILL DR",
            "address_2": "SUITE 1",
            "city": "CONROE",
            "state": "TX",
            "postal_code": "773858963",
            "telephone_number": "281-292-2255",
            "fax_number": "281-292-2299"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GULF COAST PROSTHETICS",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-11-16",
        "last_updated": "2024-02-14",
        "certification_date": "2024-02-14",
        "status": "A",
        "authorized_official_last_name": "KMIEC",
        "authorized_official_first_name": "TRACIE",
        "authorized_official_middle_name": "LEIGHANN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "281-292-2255"
    },
    "taxonomies": [
        {
            "code": "224900000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Mastectomy Fitter",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "335E00000X",
            "taxonomy_group": "",
            "desc": "Prosthetic/Orthotic Supplier",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "332113502",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Guided Prana PLLC
• Camille A Guillaume, LPC
• Karli Kay Guity
• Gabriel Guiza, LMSW
• Gulf Coast Pathology Program PLLC
• Binita Gupta, OD
• Poonam Gupta
• Adriana Lynn Gutierrez, LPC
• Kristina D Gutierrez, PNP
• Sergio Jasael Gutierrez, MD

• Prosthetic/Orthotic Supplier in Conroe, TX
• Providers in Conroe, 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 14, 2024; 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.