1093945339 NPI number — COLORADO ORTHOTIC & PROSTHETIC SERVICES LLC

Table of content: (NPI 1093945339)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1093945339 NPI number — COLORADO ORTHOTIC & PROSTHETIC SERVICES LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COLORADO ORTHOTIC & PROSTHETIC SERVICES 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:
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:
1093945339
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/19/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8111 E LOWRY BLVD
Provider Second Line Business Mailing Address:
STE 220
Provider Business Mailing Address City Name:
DENVER
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
80230-7193
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
720-858-1111
Provider Business Mailing Address Fax Number:
720-858-7052

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
622 ELKTON DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
COLORADO SPRINGS
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80907-3514
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
719-577-2533
Provider Business Practice Location Address Fax Number:
720-858-7052
Provider Enumeration Date:
07/21/2009

Additional Information

Authorized Official

Authorized Official Last Name:
NALDER
Authorized Official First Name:
DAVID
Authorized Official Middle Name:
MICHAEL
Authorized Official Title or Position:
PARTNER
Authorized Official Telephone Number:
719-577-2533

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 335E00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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