Provider Demographics
NPI:1285184754
Name:ENVISION BRACING
Entity Type:Organization
Organization Name:ENVISION BRACING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:IBETH
Authorized Official - Middle Name:
Authorized Official - Last Name:BUITRAGO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:307-213-6006
Mailing Address - Street 1:1108 14TH ST
Mailing Address - Street 2:SUITE 148
Mailing Address - City:CODY
Mailing Address - State:WY
Mailing Address - Zip Code:82414-3743
Mailing Address - Country:US
Mailing Address - Phone:307-213-6006
Mailing Address - Fax:307-333-0337
Practice Address - Street 1:1108 14TH ST
Practice Address - Street 2:SUITE 148
Practice Address - City:CODY
Practice Address - State:WY
Practice Address - Zip Code:82414-3743
Practice Address - Country:US
Practice Address - Phone:307-213-6006
Practice Address - Fax:307-333-0337
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-09
Last Update Date:2018-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies