1548340136 NPI number — WESTERN SLOPE ORTHOTICS

Table of content: (NPI 1548340136)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1548340136 NPI number — WESTERN SLOPE ORTHOTICS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WESTERN SLOPE ORTHOTICS
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:
1548340136
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
840 ROOD AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GRAND JUNCTION
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
81501-3434
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
970-241-7042
Provider Business Mailing Address Fax Number:
970-248-0083

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
840 ROOD AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GRAND JUNCTION
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
81501-3434
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
970-241-7042
Provider Business Practice Location Address Fax Number:
970-248-0083
Provider Enumeration Date:
10/17/2006

Additional Information

Authorized Official

Authorized Official Last Name:
MOORE
Authorized Official First Name:
GREG
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
970-243-9255

Provider Taxonomy Codes

  • Taxonomy code: 335E00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 841108342008 , issued by the state of ( UT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 08175903 , issued by the state of ( CO ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com