Provider Demographics
NPI:1376664912
Name:ORTHOTIC PROSTHETIC CARE, LLC
Entity Type:Organization
Organization Name:ORTHOTIC PROSTHETIC CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER - PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:P
Authorized Official - Last Name:RODGERS
Authorized Official - Suffix:
Authorized Official - Credentials:CO
Authorized Official - Phone:970-203-1234
Mailing Address - Street 1:PO BOX 245
Mailing Address - Street 2:
Mailing Address - City:LOVELAND
Mailing Address - State:CO
Mailing Address - Zip Code:80539-0245
Mailing Address - Country:US
Mailing Address - Phone:970-203-1234
Mailing Address - Fax:970-797-4828
Practice Address - Street 1:750 E 57TH ST
Practice Address - Street 2:
Practice Address - City:LOVELAND
Practice Address - State:CO
Practice Address - Zip Code:80538-1246
Practice Address - Country:US
Practice Address - Phone:970-203-1234
Practice Address - Fax:970-797-4828
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-02
Last Update Date:2016-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO08002701Medicaid
CO5889870001Medicare NSC