Provider Demographics
NPI:1518289990
Name:PROSTHETIC & ORTHOTIC GROUP OF NORTHERN CO, LLC
Entity Type:Organization
Organization Name:PROSTHETIC & ORTHOTIC GROUP OF NORTHERN CO, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPERATIONS DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:SONIA
Authorized Official - Middle Name:
Authorized Official - Last Name:MARLOW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:562-595-6445
Mailing Address - Street 1:2996 GINNALA DR STE 102
Mailing Address - Street 2:
Mailing Address - City:LOVELAND
Mailing Address - State:CO
Mailing Address - Zip Code:80538-3002
Mailing Address - Country:US
Mailing Address - Phone:970-685-4002
Mailing Address - Fax:970-685-4005
Practice Address - Street 1:2996 GINNALA DR STE 102
Practice Address - Street 2:
Practice Address - City:LOVELAND
Practice Address - State:CO
Practice Address - Zip Code:80538-3002
Practice Address - Country:US
Practice Address - Phone:970-685-4002
Practice Address - Fax:970-685-4005
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-25
Last Update Date:2010-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO1234567890OtherMEDICARE & MCAID IN PROCESS