Provider Demographics
NPI:1003020066
Name:SPECTRUM PROSTHETICS AND ORTHOTICS, LLC
Entity Type:Organization
Organization Name:SPECTRUM PROSTHETICS AND ORTHOTICS, LLC
Other - Org Name:SPECTRUM ORTHOTICS & PROSTHETICS
Other - Org Type:Other Name
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:FOREST
Authorized Official - Middle Name:
Authorized Official - Last Name:SEXTON
Authorized Official - Suffix:
Authorized Official - Credentials:CPO
Authorized Official - Phone:541-734-2435
Mailing Address - Street 1:300 UNION AVE STE C
Mailing Address - Street 2:
Mailing Address - City:GRANTS PASS
Mailing Address - State:OR
Mailing Address - Zip Code:97527-5861
Mailing Address - Country:US
Mailing Address - Phone:541-955-9678
Mailing Address - Fax:541-471-4909
Practice Address - Street 1:2504 NW MEDICAL PARK DR
Practice Address - Street 2:
Practice Address - City:ROSEBURG
Practice Address - State:OR
Practice Address - Zip Code:97471-5510
Practice Address - Country:US
Practice Address - Phone:541-673-1275
Practice Address - Fax:541-471-4909
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ORTHO DEV AMERICA CORPT
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-05-09
Last Update Date:2022-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies