Provider Demographics
NPI:1346428992
Name:JOHN CALLAN ORTHOTIC SERVICES, INC.
Entity Type:Organization
Organization Name:JOHN CALLAN ORTHOTIC SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:CALLAN
Authorized Official - Suffix:
Authorized Official - Credentials:CO
Authorized Official - Phone:719-799-6529
Mailing Address - Street 1:PO BOX 1358
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80901-1358
Mailing Address - Country:US
Mailing Address - Phone:719-799-6529
Mailing Address - Fax:
Practice Address - Street 1:1729 N WEBER ST
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80907-7503
Practice Address - Country:US
Practice Address - Phone:719-799-6529
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-06
Last Update Date:2013-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO04258361-0000335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
CONPI # 1346428992OtherTRICARE
CO77100069Medicaid
CONPI 1346428992OtherHUMANA
CO5491920001Medicare NSC