Provider Demographics
NPI:1164527743
Name:SPECTRUM PROSTHETICS & ORTHOTICS, INC.
Entity Type:Organization
Organization Name:SPECTRUM PROSTHETICS & ORTHOTICS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:TREASURER
Authorized Official - Prefix:
Authorized Official - First Name:JEFF
Authorized Official - Middle Name:
Authorized Official - Last Name:BRUCE
Authorized Official - Suffix:
Authorized Official - Credentials:CO
Authorized Official - Phone:515-956-4920
Mailing Address - Street 1:1349 NW 121ST ST
Mailing Address - Street 2:#300
Mailing Address - City:CLIVE
Mailing Address - State:IA
Mailing Address - Zip Code:50325-8145
Mailing Address - Country:US
Mailing Address - Phone:515-956-4920
Mailing Address - Fax:515-956-4021
Practice Address - Street 1:3600 LINCOLN WAY
Practice Address - Street 2:
Practice Address - City:AMES
Practice Address - State:IA
Practice Address - Zip Code:50014-7595
Practice Address - Country:US
Practice Address - Phone:515-956-4920
Practice Address - Fax:515-956-4021
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-14
Last Update Date:2009-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier