1053560425 NPI number — ORTHO LIMITED LIABILITY COMPANY, PROFESSIONAL LLC

Table of content: MR. JAY DOUGLAS SLUSHER MSPT (NPI 1780937268)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1053560425 NPI number — ORTHO LIMITED LIABILITY COMPANY, PROFESSIONAL LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ORTHO LIMITED LIABILITY COMPANY, PROFESSIONAL LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1053560425
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/10/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3715 BLOOMINGTON ST
Provider Second Line Business Mailing Address:
SUITE 160
Provider Business Mailing Address City Name:
COLORADO SPRINGS
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
80922-3204
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
719-599-0665
Provider Business Mailing Address Fax Number:
719-599-0591

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3715 BLOOMINGTON ST
Provider Second Line Business Practice Location Address:
SUITE 160
Provider Business Practice Location Address City Name:
COLORADO SPRINGS
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80922-3204
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
719-599-0665
Provider Business Practice Location Address Fax Number:
719-599-0591
Provider Enumeration Date:
09/10/2008

Additional Information

Authorized Official

Authorized Official Last Name:
RATHKE
Authorized Official First Name:
BENJAMIN
Authorized Official Middle Name:
M
Authorized Official Title or Position:
TEAM LEADER
Authorized Official Telephone Number:
719-599-0665

Provider Taxonomy Codes

  • Taxonomy code: 1223X0400X , with the licence number:  7606 , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 1223X0400X , with the licence number: 7582 , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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