Provider Demographics
NPI:1437343142
Name:LIFE ORTHOTICS
Entity Type:Organization
Organization Name:LIFE ORTHOTICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:AMMIE
Authorized Official - Middle Name:J
Authorized Official - Last Name:JAGGARS
Authorized Official - Suffix:
Authorized Official - Credentials:CDME
Authorized Official - Phone:303-928-1520
Mailing Address - Street 1:9220 KIMMER DR STE 270A
Mailing Address - Street 2:
Mailing Address - City:LONE TREE
Mailing Address - State:CO
Mailing Address - Zip Code:80124-2878
Mailing Address - Country:US
Mailing Address - Phone:303-928-1520
Mailing Address - Fax:720-294-0170
Practice Address - Street 1:9220 KIMMER DR STE 270A
Practice Address - Street 2:
Practice Address - City:LONE TREE
Practice Address - State:CO
Practice Address - Zip Code:80124-2878
Practice Address - Country:US
Practice Address - Phone:303-928-1520
Practice Address - Fax:720-294-0170
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-05
Last Update Date:2020-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO473593889Medicaid