Provider Demographics
NPI:1073082392
Name:PRECISION ORTHOTICS & PROSTHETICS, LLC
Entity Type:Organization
Organization Name:PRECISION ORTHOTICS & PROSTHETICS, LLC
Other - Org Name:POP PROSTHETICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP OF FINANCE, CONTROLLER
Authorized Official - Prefix:
Authorized Official - First Name:AARON
Authorized Official - Middle Name:
Authorized Official - Last Name:KRATOHVIL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-550-8760
Mailing Address - Street 1:526 S TONOPAH DR STE 120
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89106-4044
Mailing Address - Country:US
Mailing Address - Phone:702-243-7671
Mailing Address - Fax:702-259-7671
Practice Address - Street 1:7350 W CHEYENNE AVE STE 110
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89129-7407
Practice Address - Country:US
Practice Address - Phone:702-243-7671
Practice Address - Fax:702-259-7671
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-15
Last Update Date:2021-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV250010837Medicaid
NV5503020003OtherMEDICARE