Provider Demographics
NPI:1043603228
Name:ORTHOPEDIC SERVICES-KIDS LLC
Entity Type:Organization
Organization Name:ORTHOPEDIC SERVICES-KIDS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:A
Authorized Official - Last Name:ALVARADO
Authorized Official - Suffix:
Authorized Official - Credentials:BCO
Authorized Official - Phone:575-556-9568
Mailing Address - Street 1:2465 BATAAN MEMORIAL W
Mailing Address - Street 2:UNIT 2
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88012-5039
Mailing Address - Country:US
Mailing Address - Phone:575-556-9568
Mailing Address - Fax:
Practice Address - Street 1:2465 BATAAN MEMORIAL W
Practice Address - Street 2:UNIT 2
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88012-5039
Practice Address - Country:US
Practice Address - Phone:575-556-9568
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-11
Last Update Date:2015-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier