Provider Demographics
NPI:1497026074
Name:CAPITAL ORTHOTICS & PROSTHETICS, LLC
Entity Type:Organization
Organization Name:CAPITAL ORTHOTICS & PROSTHETICS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:T
Authorized Official - Last Name:ROGERS
Authorized Official - Suffix:
Authorized Official - Credentials:CO
Authorized Official - Phone:603-226-0106
Mailing Address - Street 1:246 PLEASANT ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:CONCORD
Mailing Address - State:NH
Mailing Address - Zip Code:03301-2548
Mailing Address - Country:US
Mailing Address - Phone:603-226-0106
Mailing Address - Fax:603-226-0845
Practice Address - Street 1:15 NELSON ST
Practice Address - Street 2:1ST FLOOR
Practice Address - City:MANCHESTER
Practice Address - State:NH
Practice Address - Zip Code:03103
Practice Address - Country:US
Practice Address - Phone:603-425-0106
Practice Address - Fax:603-425-0108
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-13
Last Update Date:2015-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT1006572Medicaid
NH30760132Medicaid
NH1250850002OtherMEDICARE PTAN
NH1209857Y0NH01OtherANTHEM
NH703776OtherHARVARD PILGRIM
NH=========OtherTRICARE
NH=========OtherGREAT WEST
NH703776OtherHARVARD PILGRIM