{"npi":"1801130620","type":"NPI-2","status":"active","name":{"display":"Gulf Coast Prosthetics","other":[],"organization_name":"GULF COAST PROSTHETICS","authorised_official":"Tracie Kmiec"},"specialty":{"primary_taxonomy":"335E00000X","primary_taxonomy_description":"Prosthetic/Orthotic Supplier","slug":"prosthetic-orthotic-supplier","schema_org_specialty":null,"all":[{"code":"224900000X","description":"Mastectomy Fitter","primary":false,"state":null,"license":null},{"code":"335E00000X","description":"Prosthetic/Orthotic Supplier","primary":true,"state":null,"license":null}]},"addresses":[{"purpose":"LOCATION","street_1":"27350 BLUEBERRY HILL DR","city":"CONROE","state":"TX","postal_code":"773858963","country_code":"US","street_2":"SUITE 1","phone":"2812922255","fax":"2812922299"},{"purpose":"MAILING","street_1":"27350 BLUEBERRY HILL DR","city":"CONROE","state":"TX","postal_code":"773858963","country_code":"US","street_2":"SUITE 1","phone":"8326057466"}],"license":null,"identifiers":[{"type_code":"05","label":"Medicaid","value":"332113502","state":"TX","issuer":null}],"pecos":{"enrolled_at":"2026-05-09T10:41:39.028268+00:00","enrollments":[{"enrlmt_id":"O20130531000131","type_code":"30-56","type_desc":"DME SUPPLIER - PROSTHETIC PERSONNEL","state":"TX","pac_id":"3375781453"}]},"enumeration_date":"2012-11-16","last_updated":"2024-02-14","_meta":{"source":"NPPES","snapshot_date":"2024-02-14","doc_url":"https://findmynpi.com/api"}}