Gaston Avenue Prosthetics, Llc

Amputee NPI1245214568

Summary

Provider Details

NPI Number 1245214568
Provider Name Gaston Avenue Prosthetics, Llc
Authorized Official Name: Catherine Amy Miller-Mehary
Title: President
Phone: 214-265-5060
Status
Entity Type Organization
Enumeration Date 11/30/2005
Last Update Date 01/30/2012
Organization Subpart N

Contact Details

Business Practice address 9900 N CENTRAL EXPY, Dallas,
75231-4395 Texas View on Google Map
Business Practice phone 214-265-5060
Business Practice fax 214-265-9055
Mailing address 9900 N CENTRAL EXPY, Dallas,
75231-4395 Texas View on Google Map
Other phone 214-265-5060
Other fax 214-265-9055
Email Address shannonfig@domain.com Reval Email Address
Incorrect information? Update the NPI Details for Update NPI
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Provider Taxonomy Details

Provider Taxonomy 1
Taxonomy
License No.
101185 (Texas)
Primary Taxonomy
Grouping name
Taxonomy
License No.
101185 (Texas)

Reference NPI Information (as per NPPES NPI Record)

Field Name Field Value
NPI 1245214568
10-position all-numeric identification number assigned by the NPS to uniquely identify a health care provider.
Entity Type Organization
Code describing the type of health care provider that is being assigned an NPI. Codes are:
  • 1 = (Person): individual human being who furnishes health care;
  • 2 = (Non-person): entity other than an individual human being that furnishes health care (for example, hospital, SNF, hospital subunit, pharmacy, or HMO).
Is Organization Subpart N
The "Is the organization a subpart?" question must be answered. If the organization is a subpart = , the Parent Organization Legal Business Name (LBN) and Parent Organization Taxpayer Identification Number (TIN) fields must be completed. The Parent Organization LBN and TIN fields can only be completed if the answer to the subpart question is Yes. Many organization health care providers who apply for NPIs are not legal entities themselves but are parts of other organization health care providers that are legal entities (the "parents"). Here are three examples of organization health care providers that may be considered subparts and may apply for NPIs if so directed by their "parents": (1) The psychiatric unit in a hospital is not a legal entity but is part of the hospital (the "parent"), which is a legal entity. The legal entity must obtain an NPI. The psychiatric unit is an example of a subpart that could have its own NPI if the hospital determines that it should. (2) A group practice that is not a sole proprietorship has a main location and could have other offices in different locations, but each office is not a separate legal entity; instead, each office is part of the corporation (the "parent") which is a legal entity. The offices are examples of subparts that could have their own NPIs if the main location determines that they should. (3) A pharmacy fills prescriptions for patients whose physicians have prescribed medications for them and may also rent or sell durable medical equipment to patients whose physicians have ordered such equipment for them. Neither the pharmacy line of business nor the DME line of business represent legal entities; instead, both lines of business are part of an organization (the "parent") that is a legal entity. Each line of business represents a different Healthcare Provider Taxonomy or area of specialization that often submits its own electronic claims to health plans. The "parent"-we don't know who the parent is in this example-must ensure that each subpart that submits its own claims to health plans has its own NPI.
Provider Organization Name (Legal Business Name) Gaston Avenue Prosthetics, Llc
Provide organization name (legal business name used to file tax returns with the IRS). The Organization Name field allows the following special characters: ampersand, apostrophe, "at" sign, colon, comma, forward slash, hyphen, left and right parentheses, period, pound sign, quotation mark, and semi-colon. A field cannot contain all special characters.
Provider Other Organization Name Gaston Avenue Prosthetics, Llc
Other name by which the organization provider is or has been known.
Provider Other Organization Name Type Code Gaston Avenue Prosthetics, Llc
Code identifying the type of other name. Codes are: 3 = doing business as (d/b/a) name; 4 = former legal business name; 5 = other.
Provider First Line Business Mailing Address 9900 N CENTRAL EXPY
The first line mailing address of the provider being identified. This data element may contain the same information as ''Provider first line location address''.
Provider Business Mailing Address City Name Dallas
The City name in the mailing address of the provider being identified. This data element may contain the same information as ''Provider location address City name''.
Provider Business Mailing Address State Name Texas
The State or Province name in the mailing address of the provider being identified. This data element may contain the same information as ''Provider location address State name''.
Provider Business Mailing Address Postal Code 75231-4395
The postal ZIP or zone code in the mailing address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available. This data element may contain the same information as ''Provider location address postal code''.
Provider Business Mailing Address Country Code US
The country code in the mailing address of the provider being identified. This data element may contain the same information as ''Provider location address country code''.
Provider Business Mailing Address Telephone Number 214-265-5060
The telephone number associated with mailing address of the provider being identified. This data element may contain the same information as ''Provider location address telephone number''.
Provider Business Mailing Address Fax Number 214-265-9055
The fax number associated with the mailing address of the provider being identified. This data element may contain the same information as ''Provider location address fax number''.
Provider First Line Business Practice Location Address 9900 N CENTRAL EXPY
The first line location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.
Provider Business Practice Location Address City Name Dallas
The city name in the location address of the provider being identified.
Provider Business Practice Location Address State Name Texas
The State or Province name in the location address of the provider being identified.
Provider Business Practice Location Address Postal Code 75231-4395
The postal ZIP or zone code in the location address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available.
Provider Business Practice Location Address Country Code US
The country code in the location address of the provider being identified.
Provider Business Practice Location Address Telephone Number 214-265-5060
The telephone number associated with the location address of the provider being identified.
Provider Business Practice Location Address Fax Number 214-265-9055
The fax number associated with the location address of the provider being identified.
Provider Enumeration Date 11/30/2005
The date the provider was assigned a unique identifier (assigned an NPI).
Last Update Date 01/30/2012
The date that a record was last updated or changed.
Authorized Official Last Name Miller-Mehary
The last name of the person authorized to submit the NPI application or to change NPS data for a health care provider.
Authorized Official First Name Catherine
The first name of the authorized official
Authorized Official First Name Amy
The middle name of the authorized official
Authorized Official Title or Position President
The title or position of the authorized official
Authorized Official Telephone Number 214-265-5060
The 10-position telephone number of the authorized official.
Healthcare Provider Taxonomy Code #1 261QA0900X
The Health Care Provider Taxonomy code is a unique alphanumeric code, ten characters in length. The code set is structured into three distinct "Levels" including Provider Type, Classification, and Area of Specialization.
Healthcare Provider Taxonomy 1 An entity, facility, or distinct part of a facility providing counseling, fitting, custom design, prescriptive, and training services related to congenital or postoperative absence of all or part of a limb or limbs.
Healthcare Provider Taxonomy #1
Provider License Number 1 101185
Certain taxonomy selections will require you to enter your license number and the state where the license was issued. Select Foreign Country in the state drop down box if the license was issued outside of United States. The License Number field allows the following special characters: ampersand, apostrophe, colon, comma, forward slash, hyphen, left and right parentheses, period, pound sign, quotation mark, and semi-colon. A field cannot contain all special characters. DO NOT report the Social Security Number (SSN), IRS Individual Taxpayer Identification Number (ITIN) in this section.
Provider License Number State Code 1 TX
Provider License Number State Code #1
Healthcare Provider Primary Taxonomy Switch 1 N
Primary Taxonomy:
  • X - The primary taxonomy switch is Not Answered;
  • Y - The taxonomy is the primary taxonomy (there can be only one per NPI record);
  • N - The taxonomy is not the primary taxonomy.
Healthcare Provider Taxonomy Code #2 335E00000X
The Health Care Provider Taxonomy code is a unique alphanumeric code, ten characters in length. The code set is structured into three distinct "Levels" including Provider Type, Classification, and Area of Specialization.
Healthcare Provider Taxonomy 2 An organization that provides prosthetic and orthotic care which may include, but is not limited to, patient evaluation, prosthesis or orthosis design, fabrication, fitting and modification to treat limb loss for purposes of restoring physiological function and/or cosmesis or to treat a neuromusculoskeletal disorder or acquired condition.
Healthcare Provider Taxonomy #2
Provider License Number 2 101185
Certain taxonomy selections will require you to enter your license number and the state where the license was issued. Select Foreign Country in the state drop down box if the license was issued outside of United States. The License Number field allows the following special characters: ampersand, apostrophe, colon, comma, forward slash, hyphen, left and right parentheses, period, pound sign, quotation mark, and semi-colon. A field cannot contain all special characters. DO NOT report the Social Security Number (SSN), IRS Individual Taxpayer Identification Number (ITIN) in this section.
Provider License Number State Code 2 TX
Provider License Number State Code #2
Healthcare Provider Primary Taxonomy Switch 2 Y
Primary Taxonomy:
  • X - The primary taxonomy switch is Not Answered;
  • Y - The taxonomy is the primary taxonomy (there can be only one per NPI record);
  • N - The taxonomy is not the primary taxonomy.